Clinical rotations for end-of-life care

As veterinary medicine continues to evolve, so too do the expectations placed on new graduates, early-career veterinarians, and specialists. Today’s practitioners must be clinically skilled, emotionally intelligent, and adept at guiding clients through complex, value-laden decisions. One of the most effective, and often overlooked, ways to develop these competencies is through comparative clinical rotations, externships, or internship/residency electives in veterinary hospice and palliative care settings.

Although hospice and palliative care rotations are sometimes perceived as niche or narrowly focused, the reality is quite the opposite. These experiences offer durable clinical, communication, and professional skills that translate directly into improved patient care, stronger client relationships, and greater career sustainability across all areas of veterinary medicine.

Why complete a clinical rotation in hospice and palliative care?

Clinical rotations are structured educational experiences, often ranging from 1 to 4 weeks, embedded within third- or fourth-year student externships, rotating or specialty internships, or residency electives. For hospice and palliative care practices, these rotations typically include participating in the following:

• In-home hospice and palliative care consultations
• Advanced pain and symptom management
• Quality-of-life assessment and monitoring
• End-of-life decision-making support
• In-home euthanasia
• Interdisciplinary collaboration with veterinary technicians, client care coordinators, and grief support professionals

Unlike traditional, hospital-based rotations that emphasize diagnostics and intervention, hospice and palliative care rotations emphasize contextualized comfort-focused medicine: tailoring care plans to the patient’s medical condition; the family’s goals, values, and resources; and the realities of the human–animal bond. A survey of veterinary schools revealed that, on average, less than 3 hours were devoted to training euthanasia methods and techniques.1

Despite the lack of extensive training, facilitating euthanasia was considered a day 1 core competency by all veterinary schools responding to that survey.1 It was also noted that there is no requirement for a veterinary student to perform or be present for a euthanasia procedure before graduation; much of it is left up to chance regarding the cases students are assigned to and their outcome. Virginia-Maryland College of Veterinary Medicine has recognized this shortfall and now dedicates more than 30 hours of end-of-life training to its veterinary students.2

Student perspectives from hospice and palliative care rotations

The value of hospice and palliative care rotations is perhaps best illustrated through the experiences of students who have completed them. Ethan, a student extern from the Ontario Veterinary College, reflected on the diversity and depth of exposure they received during a week with an in-home veterinary hospice and euthanasia service provider.

“I had the luck to shadow 5 different doctors. It was very valuable to see the different approaches to the anesthetic and euthanasia protocols, as well as excellent communication and client care to help ease the owners’ grief,” they said.

Similarly, Alex, an extern from Colorado State University, emphasized the confidence and preparedness they gained through hands-on observation and mentorship with the same organization. “I chose to do this because I don’t feel that we get enough euthanasia experience as students, and I was so glad I chose to do this to gain more of that. I truly feel that the shadowing that I did during this externship will help me immensely as a doctor—not only the communication skills that I observed, but the dosage and medication protocols and body care [handling techniques] afterward were so invaluable,” Alex said.

These reflections highlight a common theme among participants: exposure to compassionate, individualized approaches to end-of-life care that are rarely emphasized in traditional veterinary curricula yet profoundly shape clinical confidence and professional identity.

Clinical skills that translate across practice types

One of the greatest long-term benefits of a hospice and palliative care rotation is the clinical confidence it builds in communicating with families and managing chronic and complex diseases, which are frequently seen in older and geriatric patient populations. Participants gain hands-on experience with the following:

• Multimodal pain management (including opioids, adjuvant analgesics, integrative therapies, and nonpharmacologic strategies)
• Management of end-stage conditions such as cancer, advanced osteoarthritis, heart failure, renal disease, and neurologic disorders
• Recognizing and responding to subtle changes in comfort and function
• Balancing pet and caregiver treatment burdens with patient welfare

These skills are directly applicable in general practice, emergency medicine, internal medicine, oncology, and specialty care, particularly when curative options are limited, have been exhausted, or are no longer aligned with the client's goals for their pet.

Mastering quality-of-life conversations

Perhaps the most transformative aspect of a hospice and palliative care rotation is exposure to high-quality communication around quality of life, suffering, and end-of-life decisions. Trainees learn how to do the following:

• Use validated quality-of-life and pain assessment tools
• Facilitate shared decision-making without coercion or judgment
• Address uncertainty and emotional distress with professionalism and empathy
• Reframe “nothing more can be done” into “there is still much we can do”

Veterinarians report higher visit-specific satisfaction when appointments are augmented through the use of communication that builds relationships with clients.3 That satisfaction is also associated with degrees of veterinarian empathetic concern and veterinarian self-esteem. Learning these skills, therefore, is critical to overall job satisfaction and its potential link to the holistic health and well-being of veterinarians.

Improving client trust and retention

From a practice management perspective, veterinarians with training in hospice and palliative care are uniquely positioned to enhance client trust and loyalty. Clients remember how they were supported during their pet’s most vulnerable moments. A clinician who can confidently guide families through end-of-life care strengthens the reputation of their practice as compassionate, thorough, and client-centered. Graduates who have completed these rotations can become informal leaders within their clinics, mentoring colleagues, improving euthanasia protocols, and advocating for better pain management and follow-up care.

Building emotional resilience and career longevity

Veterinary burnout and compassion fatigue remain pressing concerns. Hospice and palliative care rotations offer structured exposure to emotionally challenging cases with mentorship and support. Trainees learn practical strategies for the following:

• Setting professional boundaries
• Processing grief and loss
• Recognizing caregiver burden (on the part of both client and clinician)
• Sustaining clinical empathy without self-sacrifice

These skills are critical for long-term career sustainability, regardless of practice setting. Visiting veterinary students and house officers are also exposed to support networks and interdisciplinary approaches for client grief support, as well as internal professional support networks and resources.

A strategic investment in future practice

Clinical electives with Caring Pathways or similar end-of-life care practices are focused on expanding competence. They prepare veterinarians to meet the realities of modern practice: aging pets, informed clients, ethical complexity, and the need for compassionate, individualized care.

Whether a veterinarian plans to enter general practice, emergency medicine, specialty care, or pursue advanced training, a rotation in hospice and palliative care would be a valuable experience that equips them with the tools to shape how they practice medicine for decades to come.

In the long run, the ability to care well, especially at the end of life, is not an optional skill. It is a defining mark of clinical excellence.

Tyler Carmack, DVM, CVA, CVFT, CHPV, CTPEP, CVPP, is the director of hospice and palliative care at Caring Pathways, a national at-home end-of-life veterinary practice. She founded Hampton Roads Veterinary Hospice, based in Virginia, in 2011 and has developed a special interest in integrative approaches to palliative pain management.

References

1. Cooney K, Dickinson GE, Hoffman H. Euthanasia education in veterinary schools in the United States. J Vet Med Educ. 2021;48(6):706–709. doi:10.3138/jvme-2020-0050
2. Corrigan VK, Cooney K, Foster R. Compassionate end-of-life care: development, implementation, and evaluation of a comprehensive euthanasia course in veterinary education from 2019–2024. Hum Anim Interact. 2025;13(1). doi:10.1079/hai.2025.0025
3. Shaw JR, Adams CL, Bonnett BN, Larson S, Roter DL. Veterinarian satisfaction with companion animal visits. J Am Vet Med Assoc. 2012;240(7):832–841. doi:10.2460/javma.240.7.832