Download VETM 3430 Clin Med Course Outline Aug 27 2013

Approved: August 27, 2013
Clinical Medicine I, VETM*3430 Fall/Winter 2013-­‐2014 0.25 Credits Calendar Description The course will contribute to students' achievement of selected elements of graduating competency in the areas of animal handling and the clinical examination of various species. Students will become familiar with the expected variation in common clinical parameters and how this variation is impacted by aging, changes in health status, and external environmental influences and other sources of stress. Students will be introduced to clinical problem solving using case material from the Veterinary Teaching Hospital. They will develop their verbal and written communication skills through case simulations and analyses. The course will be presented using lectures, laboratory classes and independent study. The graduating competencies can be found on the OVC website (http://www.ovcnet.uoguelph.ca/homepage/html). Department of Clinical Studies. Course Coordinators Dr. Joanne Hewson (Large Animal) Department of Clinical Studies, Room 2519, ext. 58496 E-­‐mail: [email protected] Dr. Shauna Blois (Small Animal) Department of Clinical Studies, Room 2111, ext. 54419 E-­‐mail: [email protected] Instructors Small and Large Animal Medicine Faculty (Department of Clinical Studies) Ruminant Field Service Faculty (Department of Population Medicine) Dr. Patricia Turner (Department of Pathobiology) Graduate Students (Department of Clinical Studies) Clinical Residents, Small and Large Animal Interns and AHT’s (Veterinary Teaching Hospital) Administrative Information For questions regarding academic consideration, continuation of study, academic misconduct, safety, confidentiality, and experiential learning involving use of animals, please refer to the Phase 1 information on the OVC website. Approved: August 27, 2013
Course Objectives Lectures and laboratories are designed to address the following course objectives. Although lectures and laboratories will introduce the skills required to meet these objectives, students will need to pursue considerable self-­‐study practice of these skills in order to master them at a level that is required to pass this course. Graduates of this course must be able to: • Obtain a relevant and accurate history pertinent to the species being examined. • Handle and restrain animals in a safe and humane manner. • Perform a thorough and systematic general physical examination of animals and a general assessment of their environment. • Explain the principles of a problem-­‐oriented medical approach. • Develop an initial problem list based on history and physical examination. • Identify the landmarks and list precautions to consider with regard to obtaining blood samples and medicating animals. • Perform enteral and parenteral techniques for administration of medications to large animal species. This course is the first of three Clinical Medicine courses that veterinary students will encounter throughout the DVM curriculum. VETM*3430 Clinical Medicine I introduces aspects of the clinical evaluation as outlined above. These objectives are then built upon, becoming more detailed and clinically advanced, in the Clinical Medicine courses of Phases 2 and 3. Students are expected to view the course contents of Clinical Medicine I as life-­‐long learning of skills that will be needed during their career in veterinary medicine. Therefore, information taught during Clinical Medicine I will also be examined as a component of future Clinical Medicine courses in Phases 2 and 3 of the DVM program. Primary Healthcare Centre 1. Describe the components of a vaccination record. 2. Identify additional components of a physical exam/appointment that are necessary for pediatric patients compared to adult patients. 3. Identify additional components of a physical exam/appointment that are necessary for geriatric patients compared to middle-­‐aged patients. 4. List diagnostic tools used to assess a sick patient during an examination. 5. Perform a pre-­‐surgical physical examination on a healthy animal. 6. Describe the steps that are followed in order to prepare a patient for surgery. 7. Identify the major anatomical structures and landmarks important in the procedure. 8. Describe the signs of post-­‐surgical pain. 9. Describe why the surgical/dental procedure is going to be performed. 10. Describe what physiologic parameters are monitored during surgery/dentistry and list the normal ranges for these parameters. Approved: August 27, 2013
11. Describe three rehabilitation techniques. 12. Describe components of a weight management program in dogs. 13. Describe how clinical procedures (e.g., bandage change, wound cleaning, cystocentesis) are performed. 14. Identify how the 5 stages of the Calgary-­‐Cambridge Guide interview structure are used in PHC client interviews. Course Description This course consists of nine lectures (see Appendix I); thirteen animal-­‐oriented laboratories devoted to physical examination, restraint and medication techniques (6 involving large animals, 6 involving small domestic animals, and 1 involving small mammal species; see Appendix II); and prescribed self-­‐study material available on the Courselink website for this course. Due Diligence: Safety in the clinic and barn is a priority at all times. In order to ensure safety of all participants, the safety procedures/guidelines provided by the instructor must be followed. It is the responsibility of each student to attend any safety orientation that is provided. Approved: August 27, 2013
Personal Attire in Large Animal Laboratories: As well as protective coveralls, students are required by the University of Guelph safety policy to wear approved safety boots or shoes (steel-­‐toed). Students will NOT be permitted to participate in scheduled activities involving large animals if they do not comply. Lab coats are not permitted in the Large Animal Laboratories. Self-­‐Study & Access to Animals in the Veterinary Teaching Hospital: Scheduling constraints limit the amount of class time available for Clinical Medicine laboratories. To achieve a satisfactory skill level, students must take advantage of opportunities to practice performing physical examinations and to evaluate clinical material: − Large animal species (cattle, horses, sheep) housed in Barn 37 will be accessible for practice outside of laboratory time only during regular working hours (Monday to Friday, 8am to 4pm). Prior to large animal use for practice, an Animal Use Request Form must be completed and permission must be obtained from the designated contact on the form (Caitrin Ollerhead De Santis: [email protected]). This is essential in order to avoid inadvertent overuse of individual animals as they are shared between multiple courses. For safety reasons, you must work together in groups of 3 or more students when practicing with the large animal species. Coveralls and steel-­‐toed footwear are required. − The dogs used in most small animal labs are from the University of Guelph Central Animal Facility (CAF). These dogs are accessible for practice outside of laboratory time during CAF regular business hours. Please contact Annette Morrison at CAF ([email protected]) to arrange practice times. − There is no additional practice time for small mammal species outside of the regular laboratory time. Client Confidentiality: At times in this course you may work with client-­‐owned animals. Please note that access to the clinical record is a PRIVILEGE, not a right, and must be protected. You are reminded that all medical record information must be treated as ABSOLUTELY CONFIDENTIAL and must NOT be discussed outside of the College. In particular, the identity of clients and their animals must NEVER be divulged to anyone who does not have Medical Records privileges (see VTH Policies and Procedures Book and VTH Undergraduate Hospital Manual). Student postings of case pictures or descriptions of cases using social media is strictly prohibited. Hygiene: Handwashing is the single most important procedure for preventing the spread of infections. Incorporate this procedure into your routine before and after patient contact or contact with animal bodily fluids, excretions/secretions or contaminated inanimate objects. Wet your hands and apply 3-­‐5 ml of soap and scrub your entire hands vigorously for at least 10 seconds. *When handling client-­‐owned large animal species, the use of gloves is required. Please also wash hands following removal of gloves. Approved: August 27, 2013
Coveralls and Footwear – Large Animal Section: Before exiting Barn 37 or the VTH, thoroughly wash your boots with disinfectant solution that is provided or use the disinfecting boot mats. Coveralls should be laundered through the VTH following each laboratory and before using them for other courses. Digital Recording: Digital recording and photography are not permitted during lectures and laboratories in this course. Teaching Strategies The process of conducting a client interview to obtain a general history is common to all species. Although this activity will be predominantly demonstrated and practiced in the Small Animal component of this course, limited experience in history taking will also be practiced in the Large Animal labs. Students are expected to transfer skills learned in the Small Animal labs to a Large Animal context and become proficient in history taking of all species taught in this course through opportunities arising within, and outside of, this course. In both the Small and Large Animal Sections of the course, students will be expected to know relevant anatomy and lay and anatomical terms. * NOTE: It is expected that students will conduct themselves in such a manner during this course that neither personal, peer or instructor safety will be compromised, and animal safety and welfare will be optimized. The expectation is that students will demonstrate confidence and common sense while working around and with domestic animals. Students are required to be able to recognize the common premonitory signs of aggressive or potentially aggressive behavior in all species encountered in this course, as well as situations that could precipitate such behavior. Students are expected to anticipate and take appropriate action to avoid human injury at all times. Experiential learning is also built into this course to support the skills learned in the course lectures and laboratories. This is through Phase I student shadowing of students on clinical rotations in Phase 4, as well as through shifts working in the Primary Healthcare Centre. Specifically, experiential learning will include the following mandatory components: -­‐ Phase 4 shadowing in the Large Animal Clinic at OVC -­‐ Phase 4 shadowing in the Small Animal Clinic at OVC -­‐ Shifts at the Primary Healthcare Centre at OVC LARGE ANIMAL SECTION I. LABORATORIES This component involves a series of 4, animal-­‐oriented, hands-­‐on laboratories, plus a practical review laboratory and a final laboratory session in which oral Approved: August 27, 2013
examinations are conducted. Each laboratory group consists of approximately ¼ of the class. Typically, each laboratory period will involve primarily active practice of the skills outlined in the objectives for each laboratory. Students are expected to adequately prepare for each laboratory prior to attending, by thorough review of the online supporting material provided for each lab topic. The majority of live animal demonstrations in this course have been replaced by online videos, and students are therefore expected to know this material in advance of working with live animals in this course. Laboratories start promptly at the assigned time, therefore students are expected to arrive on time and dressed appropriately for the laboratory. Students will be expected to be familiar or become familiar with all anatomic information and terminology relevant to general physical examination. Students will be expected to resolve any learning issues that arise by discussion with laboratory instructors, classmates, or by consulting reference texts or other learning resources. II. REQUIRED SELF-­‐STUDY a. Course Website: D2L (Courselink) Material: Prior to each Large Animal Laboratory, students are expected to review the laboratory objectives and master the assigned background reading or video material posted on Courselink relevant to that particular laboratory. Students are expected to come to the laboratory proficient in this material in order to optimize their learning during the laboratory time. b. Practice of Acquired Skills: Students are expected to visit Barn 37 regularly to practice the skills taught in the Large Animal Laboratories. Please work in groups of no less than 3 people in order to ensure each other’s safety at all times. Barn 37 may only be accessed during regular daytime hours and is locked in the evenings and on weekends. Proper attire is required at all times when practicing with the large animal teaching animals (coveralls, steel-­‐toed footwear) and use of teaching animals requires prior submission of an Animal Use Request form. Do not practice medication techniques (e.g. needling or tubing animals) outside of the designated laboratory time when faculty supervision is available. c. Phase 4 shadowing in the Large Animal Clinic at OVC: Each Phase 1 student will have a one week (Monday -­‐ Sunday) shift during which they are paired up with a Phase 4 student on either the Large Animal Medicine or Surgery clinical rotations. The schedule and procedure will be posted on the course website. This component of the course is NOT optional. During the assigned week of clinical shadowing, the Phase I student will accompany their Phase 4 partner during morning (before class time) and evening assessments of their patients currently admitted to the teaching hospital. Patients housed in the Large Animal Isolation Unit (LAIU) are not included in these duties; Phase I students should not accompany their Phase 4 partner into the LAIU. Shadowing of Phase 4 students is intended to provide more exposure to animal handling and restraint, and Approved: August 27, 2013
performing TPRs and patient assessments. Students are encouraged to ask lots of questions in order to understand the cases and to affirm their clinical findings. Phase I students may not administer any medications or treatments to the large animal patients, and Phase I students must only handle and evaluate patients when in the presence of their Phase 4 partner. Clean coveralls, steel-­‐
toed footwear, and name tags must be worn while in the OVC-­‐HSC Large Animal Clinic. Details will be provided and discussed in the first few class sessions before this activity begins. A Clinical Shadowing Attendance sheet must be submitted within 1 week after the Large Animal Phase 4 clinical shadowing is completed. The 4th year student they are shadowing will sign off on the attendance record. The attendance record is found on the D2L course site (file named Clinical Shadowing Attendance Sheet). There is no grade assigned to this portion of the course. If you have time conflicts and cannot attend your scheduled week, please find another classmate to switch with and inform the Large Animal course co-­‐ordination (Dr. Hewson). Please note that attendance at all morning and evening shifts for the entire 7-­‐day period is necessary in order to complete this course requirement. SMALL ANIMAL SECTION I. LABORATORIES This component involves a series of 5 laboratories, plus a final laboratory session in which oral examinations are conducted. Students will be introduced to the client interview (history-­‐taking and generation of a problem list), restraint and handling techniques, the administration of medication, and the performance of a complete general physical examination for dogs and cats. With the exception of the lab on the clinical interview, the laboratory periods will typically be divided into a presentation/discussion period and an active participation period where each student will be expected to practice or refine the skills pertinent to that or previous laboratory sessions. The live-­‐animal practice portion may involve relocating from the assigned room to another area or building. II. REQUIRED SELF-­‐STUDY a. Course Website: D2L (Courselink) Material: Course lecture and laboratory notes and instructional videos are provided on the course website to support the clinical skills taught in this course. b. Required Readings: See the SA Resource list below for relevant chapters in supplementary textbooks. c. Practice of Acquired Skills: Students are expected to spend supplementary time on self-­‐study of physical examination skills. Opportunities to interact with cats and dogs at the OVC and Central Animal Facility (CAF) should be utilized to consolidate Approved: August 27, 2013
information acquired during the laboratory sessions. The CAF dogs used in the small animal labs are accessible for practice outside of laboratory time during CAF regular business hours. Please contact Annette Morrison at CAF ([email protected]) to arrange practice times. d. Phase 4 shadowing in the Small Animal Clinic at OVC: Each Phase 1 student will have a one week (Monday – Sunday) shift during which they are paired up with a Phase 4 student on either the Small Animal Medicine or Surgery clinical rotations. The schedule and procedure will be posted on the course website. This component of the course is NOT optional. During the assigned week of clinical shadowing, the Phase I student will accompany their Phase 4 partner during morning (before class time) and evening assessments of their patients currently admitted to the teaching hospital. Shadowing of Phase 4 students is intended to provide more exposure to animal handling and restraint, and performing TPRs and patient assessments. Students are encouraged to ask lots of questions in order to understand the cases and to affirm their clinical findings. Phase I students must only handle and evaluate patients when in the presence of their Phase 4 partner. Clean lab coats and name tags must be worn while in the OVC-­‐
HSC Small Animal Clinic. Details will be provided and discussed in the first few class sessions before this activity begins. A Clinical Shadowing Attendance sheet must be submitted within 1 week after the Small Animal Phase 4 clinical shadowing is completed. The 4th year student they are shadowing will sign off on the attendance record. The attendance record is found on the D2L course site (file named Clinical Shadowing Attendance Sheet). There is no grade assigned to this portion of the course. If you have time conflicts and cannot attend your scheduled week, please find another classmate to switch with and inform the Small Animal course co-­‐ordination (Dr. Blois). Please note that attendance at all morning and evening shifts for the entire 7-­‐day period is necessary in order to complete this course requirement. SMALL MAMMAL SECTION I. LABORATORY This component involves a single animal-­‐oriented hands-­‐on tutorial and laboratory. Students will be introduced to restraint and handling techniques, and the performance of a complete general physical examination for small mammals such as rabbits and rodents. The laboratory period will be divided into an initial tutorial followed by an active participation period where each student will be expected to practice the skills pertinent to the laboratory session. The live-­‐
animal practice portion will involve relocating from the assigned room to another building. There will be no make-­‐up to the laboratory, if missed. II. REQUIRED SELF-­‐STUDY a. Course Website: D2L (Courselink) Material: Prior to the Small Mammal Laboratory, students are expected to master the assigned material posted on Approved: August 27, 2013
D2L for this laboratory. Students are expected to come to the laboratory proficient in this material to optimize their learning during the laboratory time. Experiential Learning at the Hill’s Pet Nutrition Primary Healthcare Centre The Hill’s Pet Nutrition Primary Healthcare Centre (PHC) provides an experiential learning environment that will enhance and enrich your learning. While participating in the required shifts, you will be a member of the healthcare team in the PHC. You must complete your shifts in the PHC and submit your completed e-­‐portfolio by March 31, 2014 in order to receive a numeric grade for the Clinical Medicine and Art of Veterinary Medicine courses in your Phase. If all PHC requirements are not completed by June 1, 2014, a grade of 49% will be assigned in your Clinical Medicine course unless academic consideration has been granted. For all questions about PHC scheduling and learning activities please contact Dr. Peter Conlon ([email protected]; ext. 54413/54583). Complete information about your learning at the PHC is available on the Primary Healthcare Centre CourseLink site (under the ‘Guest Graded’ tab when you log in to CourseLink). Evaluation VETM 3430 Clinical Medicine I % of Final Method of Assessment Course Grade* Large Animal Component: (46) - Midterm (All lectures + Large Animal Courselink 8 material) - Large Animal Lab Practical Examination 30 - Large Animal Final Written Examination 8 Small Animal Component: (46) - Small Animal Lab Practical Examination 23 - Small Animal Final Written Examination 23 Small Mammal Component: (8) - Small Mammal Lab Written Examination 8 *In order to achieve a passing overall grade for VETM3430: Clinical Medicine I, students must achieve all of the following: - A grade of 60% or greater on each of the Large Animal and Small Animal Lab Practical Examinations or on any conditional practical examination if required. - At least 23/46 (50%) cumulative grade within each of the Large Animal and Small Animal sections of this course. Approved: August 27, 2013
Completion of both the Large Animal and Small Animal Phase 4 shadowing weeks - Completion of the required Primary Healthcare Center shifts and submission of a completed e-­‐portfolio. Failure to achieve these requirements will result in a final overall course grade of 49% being assigned regardless of marks attained in other sections of the course, and the student will fail the course. I. CALCULATION OF GRADE FOR THE LARGE ANIMAL SECTION: The final grade in the Large Animal Section of Clinical Medicine I will be based on the following assessments of student performance. Students must achieve a minimum of 23 out of 46 possible marks in the Large Animal Section in order to pass VETM3430 Clinical Medicine I. i. Midterm Examination This will be a written midterm incorporating all material from the 9 course lectures plus all of the D2L (Courselink) material pertaining to the Large Animal laboratories. Details on the format of this examination will be provided on the course D2L website. ii. Large Animal Lab Practical Exam This will be an individual oral exam to be held during either lab 6 or 12 of the Large Animal labs. Details on the format of this examination will be provided on the course D2L website. A pass for this exam is 18/30 (60%) or greater. Students must pass this oral examination in order to pass the Large Animal Section of this course. Please note that student action(s) during the oral examination that put them, their peers or instructors at risk of injury, compromise animal safety or welfare, or actions which clearly indicate a total lack of confidence (overwhelming fear of working with domestic large animals) or total lack of competence will be grounds for a failing grade. Students who achieve less than 18/30 (60%) on the exam will be required to take a conditional repeat exam. Repeat of the live -
animal exams cannot occur within two weeks of the initial exam, to allow sufficient time for remediation. The conditional repeat examination for the live animal exams will occur on Jan 20, 2014 at 15:30 (December exam repeats) and on Apr 4, 2014 at 10:30 (May exam repeats). If a passing grade is obtained on the conditional examination, the student will be assigned 18/30 for the purpose of calculating the final course grade. Any student that fails (less than 18/30) the practical examination on the second attempt will be assigned a failing grade (49%) for the entire Clinical Medicine I course. iii. Large Animal Final Written Examination: For details on this examination, please see below. Approved: August 27, 2013
II. CALCULATION OF GRADE FOR THE SMALL ANIMAL SECTION: The final grade in the Small Animal Section of Clinical Medicine I will be based on the following assessments of student performance. Students must achieve a minimum of 23 out of 46 possible marks in the Small Animal Section in order to pass VETM3430 Clinical Medicine I. i. Small Animal Lab Practical Exam This will be an individual oral exam to be held during either lab 6 or 12 of the Small Animal labs. Students will be examined individually by a SA clinician and will be assessed on their physical examination skills (their ability to perform a thorough general physical examination) and their familiarity with normal findings. Restraint and handling skills will also be taken into consideration. A pass for this exam is 60% or greater. Students must pass this oral examination in order to pass the Small Animal Section of this course. Students who achieve less than 60% on the exam will be required to take a conditional repeat exam. Repeat of the live animal exams cannot occur within two weeks of the initial exam, to allow sufficient time for remediation. The repeat examination for the live animal exams will occur on Jan 20, 2014 at 15:30 (December exam repeats) and on Apr 4, 2014 at 10:30 (May exam repeats). If a passing grade is obtained on the conditional repeat examination, the student will be assigned 60% for the purpose of calculating the final course grade. Any student that fails the practical examination on the second attempt will be assigned a failing grade (49%) for the entire Clinical Medicine I course. ii. Small Animal Final Written Examination: For details on this exam, please see below. III. CALCULATION OF GRADE FOR THE SMALL MAMMAL SECTION: Evaluation in the Small Mammal Section will be based on a written final examination of this section in December. COMBINED LARGE AND SMALL ANIMAL FINAL WRITTEN EXAMINATION: Both Large and Small Animal Section questions will appear on the year-­‐end written exam. Greater emphasis will be placed on the small animal material. This cumulative exam will be composed of multiple choice and short answer questions, and will be based on material presented in: •
Course lectures •
All material from both LA and SA labs Approved: August 27, 2013
The required readings •
All material from the course website. The exam will include: questions regarding animal handling and restraint, the components of a complete clinical examination (including history, observation, physical examination, and the problem-­‐oriented medical approach); questions regarding specific physical exam findings in small and large animal species; still pictures and videos of animals that illustrate clinical abnormalities which must be identified and discussed in the light of history and clinical findings; the identification of and description of safe and humane use of equipment used or demonstrated during the LA laboratories; the definition of terms included in the assigned glossaries. •
Resources All notes are available on D2L. Printed course notes will not be provided. Large Animal Component 1. VETM*3430 Clinical Medicine I Course Home Page (D2L) Small Animal Component 1. VETM*3430 Clinical Medicine I Course Home Page (D2L) 2. Crow SE and Walshaw SO. Manual of Clinical Procedures in the Dog and Cat, 2nd ed, Lippincott-­‐Raven 1997. a. Chapter 1 – Restraint of Dogs and Cats b. Chapter 2 – Blood Collection (Routine Venipuncture only) c. Chapter 3 – Injection Techniques d. Chapter 5 – Oral Administration of Medications 3. Birchard SJ, Sherding RG. Saunders Manual of Small Animal Practice, 3rd ed, WB Saunders 2006. a. Chapter 1 – History and Physical Examination Small Mammal Component 2. VETM*3430 Clinical Medicine I Course Home Page (D2L) *Note: Textbooks are on Reserve in the OVC Library. Approved: August 27, 2013
Lecture* 1. Appendix I: Lectures – VETM*3430 Subject** Introduction to Small Animal Clinical Examination and the Problem-­‐
Oriented Approach to Medical Diagnosis 2. Introduction to Small Animal Clinical Examination and the Problem-­‐
Oriented Approach to Medical Diagnosis -­‐ continued 3. Introduction to Small Animal Clinical Examination and the Problem-­‐
Oriented Approach to Medical Diagnosis -­‐ continued 4. General Inspection of Large Animals & Their Environment 5. Feeding Large Animals 6. General Physical Examination of Cattle 7. General Physical Examination of Horses 8. Physical Examination and Handling of Small Ruminants 9. Principles of Infection Control *Refer to the Phase 1 class schedule for actual dates/times and locations of lectures **Lecture topics may be presented in an alternate order than listed above depending on faculty scheduling. Approved: August 27, 2013
Appendix II: Laboratories -­‐ VETM*3430: Fall: Groups A and C Large animal Winter: Groups A and C Small animal Groups B and D Small animal Groups B and D Large animal Refer to the Phase 1 class schedule for actual dates/times/locations of laboratories. Large Animal Section The following laboratory sessions will be conducted. Please refer to the final lab schedule posted on D2L (Courselink) in order to determine the order of lab topics for each semester. Mastery of all D2L material for each topic is required prior to attending the lab session. - Restraint and physical examination of cattle - Restraint and physical examination of horses - Restraint & general examination of small ruminants; dairy & equine feeds - Medication techniques of cattle and horses; physical examination of sheep - Practical review session - Oral Examinations Please note: 1. The meeting place for each lab varies within the Clinical Skills Building/Barn 37 depending on the species involved. Please consult the final lab schedule posted on D2L for the meeting location of each lab. 2. Due to the size of groups for each laboratory, we are not able to accommodate students attending a laboratory other than the one to which they are assigned. There will be no opportunity to make-­‐up any missed labs. 3. Coveralls and steel-­‐toed boots are required for all Large Animal Labs, as well as during individual practice time outside of scheduled labs. Long hair (shoulder length) should be tied back. Please remove any jewelry, including rings, prior to attending the labs. 4. Students must bring a pen, stethoscope, penlight, digital thermometer and watch to every laboratory and to the final oral examination. Small Animal Section Lab 1 The clinical interview (History) Lab 2 Restraint, Administration of Medication & Venipuncture Lab 3 General Physical Examination Lab 4 Physical Examination of the Cardiovascular & Pulmonary Systems Lab 5 Physical Examination of the Digestive and Urogenital System Lab 6 Oral Examinations Please note: Students must bring a pen, stethoscope, pen light, thermometer and watch to every laboratory and to the final oral examination. Small Mammal Section Lab 1 Restraint and Physical Examination Please note: Students must bring a lab coat, stethoscope, pen light, and watch to this laboratory.