Evaluating veterinary student skill acquisition on a laparoscopic suturing exercise after simulation training

Laparoscopy and thoracoscopy in small animal surgery: A 2020 survey of small animal diplomate and resident veterinary surgeons

OBJECTIVE

To document the utilization and training of laparoscopic and thoracoscopic minimally invasive surgery (MIS) techniques within the American, European, Australian and New Zealand Colleges of Small Animal Veterinary Surgeons (ACVS, ECVS, and ANZCVS) in 2020.

STUDY DESIGN

Observational study.

SAMPLE POPULATION

Diplomates and residents of the ACVS, ECVS, and FANZCVS.

METHODS

An electronic survey was sent using veterinary list servers. Questions were organized into categories evaluating (1) the demographics of the study population and the caseload, (2) comfort level with specific procedures, (3) motivating factors and limitations, and (4) surgical training and the role of the governing bodies.

RESULTS

Respondents included 111 practicing surgeons and 28 residents. Respondents' soft-tissue MIS caseloads had increased since they first started performing MIS; however, most respondents were only comfortable performing basic laparoscopy. Over half of the respondents agreed on the patient benefits and high standard of care provided by MIS. Perceived adequate soft-tissue training in MIS during residency was strongly associated with perceived proficiency at the time of survey response. Most respondents agreed that the specialty colleges should take a more active role in developing standards for soft-tissue MIS, with residents agreeing that a required standardized course would be beneficial.

CONCLUSION

Soft-tissue MIS is widely performed by diplomates and residents. Perceived adequate soft-tissue MIS training was strongly associated with perceived proficiency.

CLINICAL SIGNIFICANCE

There is substantial underutilization of advanced MIS techniques in veterinary specialty surgical practice, which might be improved by a stronger focus on MIS training during residency.

Trained to cut? A literature review of veterinary surgical resident training

A surgical residency trains veterinary graduates to a higher level of expertise in surgical procedures than is possible during veterinary school and prepares a resident to pursue board certification in surgery. The education of veterinary surgical residents has changed minimally since its inception in the twentieth century, and there are insufficient studies to determine if residency programs are producing surgeons with competence in each of the necessary procedural categories. The aims of this review were to report the current theory and methods used to provide surgical education to residents, to discuss the training most likely to create a competent, board-certified surgeon and to review assessment methods used during training. Several literature searches using broad terms such as "veterinary surgery residency," "veterinary surgery resident," and "veterinary surgical training" were performed using PubMed, CAB abstracts, and Google Scholar. Literature pertinent to theory, methods, training, and assessment of veterinary surgical residents was included. The reviewed literature demonstrated the need for research-based learning curves for specific procedures. Simulation training is known to facilitate deliberate practice and should be leveraged where possible to reach competency. The creation of validated assessment methods should be pursued as it enables assessment of competency instead of inferring its development from case logs. Understanding and supporting learner cognition and providing sufficient feedback remain important issues in the field. Surgical educators are urged to continue to search for innovative and evidence-based ways to train competent surgical residents.

Approaches to Laparoscopic Training in Veterinary Medicine: A Review of Personalized Simulators

Veterinary minimally invasive surgery (MIS) has experienced notable growth in recent years, yet the availability of specialized training tools remains limited and not readily accessible to practitioners worldwide. While borrowing simulators from human medicine practices suffices for acquiring fundamental laparoscopic skills, it proves inadequate when addressing procedure-specific nuances. Veterinary professionals are now taking steps to create simulators tailored to their patients, although the validation process can be time-consuming. Consequently, the availability of advanced laparoscopic simulators for veterinary training remains scarce. The present study aims to highlight custom-made simulators. A comprehensive search across five databases was conducted to uncover the simulators documented from 2010 to 2022. A total of five simulators emerged from this search, with four grounded in a canine model and only one in an equine model. These models underwent validation and were found to be effective in training surgeons for their designated tasks. The findings underscore a limited array of simulators, predominantly catering to two species (horses and dogs). Considering these findings, it is evident that further research is imperative to create laparoscopic simulators capable of facilitating advanced veterinary training. This would enable the continued evolution of surgical techniques across diverse species, including ruminants, small mammals, and non-mammalian animals.

Use of 3D Printing Technology to Create a Canine Simulator for Cerebrospinal Fluid Sampling at the Lumbar Subarachnoid Space

Cerebrospinal fluid (CSF) sampling at the lumbar subarachnoid space (LSS) is technically challenging to learn. Currently, training relies on cadaver availability or performance in a clinical scenario. This study aims to develop and validate a low-cost, high-fidelity simulator to train in this technique. Using three-dimensional printing technology, a model of a healthy adult dog's lumbosacral vertebral column was produced. The model was augmented with synthetic materials and a fluidic system to replicate all procedural steps and permit successful CSF collection. The simulator was validated by four experts, who rated it highly across multiple criteria. Final-year veterinary students were recruited to take part in practical sessions using either the simulator (n = 16) or a cadaver (n = 16). Performance was recorded for each student, and feedback was obtained using an anonymous online survey. Student performance was similar between groups (p = .2), with 87.5% and 68.75% of students in the simulator and cadaver group, respectively, successfully placing the needle into the LSS. All successful students in the simulator group were able to obtain a CSF sample, versus none in the cadaver group. No difference in the number of attempts was detected between groups (p > .99), with most students taking more than three attempts. User experience was similar between groups, with 93.8% of students in each group rating the session as a positive learning experience. In summary, we demonstrate the validity of a novel, low-cost, and anatomically precise simulator that can be used for teaching CSF sampling at the LSS.

The Use of Simulators for Teaching Practical Clinical Skills to Veterinary Students - A Review

In the context of veterinary education, simulators are devices or sets of conditions aiming to imitate real patients and enable students to practice skills without the need for live animal use. Simulator use in veterinary education has increased significantly in recent years, allowing consistent practical teaching without reliance on clinical cases. This review examines the available literature regarding the use of simulation and simulators for teaching practical day one competences to veterinary students. Scientific databases were searched and 73 relevant articles were reviewed. The reviewed articles revealed that there are a number of simulators currently available to veterinary educators, that simulators can enhance student skills and provide an alternative learning environment without the need for live animal and/or cadaver use, and that they usually receive positive feedback from the students who use them. There appears to be a bias towards small animal simulators - however, some skills that are developed through the use of small animal or table-top models will be transferrable to other species. The majority of large animal simulators focus on bovine rectal palpation and/or pregnancy diagnosis. Further research is required to increase the repertoire of available simulators for use in veterinary education, in order to improve the practical skills of veterinary students and reduce the use of live animals and cadaver material for teaching purposes.

If you build it, they will learn: A review of models in veterinary surgical education

Surgical skills are learned through deliberate practice, and veterinary educators are increasingly turning to models for teaching and assessing surgical skills. This review article sought to compile and review the literature specific to veterinary surgical skills models, and to discuss the themes of fidelity, educational outcomes, and validity evidence. Several literature searches using broad terms such as "veterinary surgery model," "veterinary surgical model," and "veterinary surgical simulator" were performed using PubMed, CAB abstracts, and Google scholar. All articles describing a model created and utilized for veterinary surgical training were included. Other review articles were used as a source for additional models. Commercially available models were found using review articles, internet browser searches, and communication with veterinary clinical skills educators. There has been an explosion of growth in the variety of small animal surgical task trainers published in the last several decades. These models teach orthopedic surgery, ligation and suturing, open celiotomy and abdominal surgery, sterilization surgeries, and minimally invasive surgeries. Some models were published with accompanying rubrics for learner assessment; these rubrics have been noted where present. Research in veterinary surgical models is expanding and becoming an area of focus for academic institutions. However, there is room for growth in the collection of validity evidence and in development of models for teaching large animal surgery, training surgical residents, and providing continuing education to practitioners. This review can assist with evaluation of current surgical models and trends, and provide a platform for additional studies and development of best practices.

Reshaping surgical specialist training in small animal surgery during and after the COVID-19 pandemic

Objective

To assess the perceived effects of the COVID‐19 pandemic on small animal surgical specialist training, among trainees and supervisors and to propose changes, based upon the results, that could be incorporated into training programs.

Study Design

Anonymous online questionnaire survey.

Sample Population

Eighty‐one eligible responses were collected in September 2020, including 52 European College of Veterinary Surgeons (ECVS) residents and 29 ECVS Diplomates acting as supervisors.

Methods

Descriptive statistics were used to analyze the data. Fisher's exact test was used to test for significance.

Results

A reduction in surgical case load was reported by 82% (n = 66/81) of respondents, with 82% (n = 54/66) of those believing that COVID‐19 had a mild‐to‐moderate impact on training. Compared to supervisors, residents were less likely to feel that appropriate guidance, a safe working environment, and measures to preserve training had been provided (p < .01). Only 45% (n = 22/49) of residents reported confidence with performing teleconsultations. Ninety percent (n = 73/81) of respondents considered online “case presentations” and “edited surgical video footage” as a positive ancillary tool.

Conclusion

COVID‐19 has resulted in a reduction in case load and training for the majority of residents. A discrepancy between the opinions of residents and supervisors was noted on various aspects of COVID‐19 related effects.

Impact

Open communication, as well as the use of additional training tools through digital platforms may help to preserve safe and effective training during times of decreased clinical activity. While this study has focused on surgical specialist training, the results could be applied to other disciplines.

Evaluation of a laparoscopic abdominal simulator assessment to test readiness for laparoscopic ovariectomy in live dogs

OBJECTIVE

To predict readiness for laparoscopic ovariectomy of live dogs on the basis of performance on a high-fidelity laparoscopic abdominal simulator and to determine interrater reliability of the assessment.

STUDY DESIGN

Experimental study.

SAMPLE POPULATION

Seventeen fourth-year veterinary students.

METHODS

After a standardized laparoscopic training course, each participant performed a laparoscopic ovariectomy with a simulator. This performance was scored in real time by two evaluators using a rubric. Participants achieving a score of 112 of 160 performed a laparoscopic ovariectomy in a live dog, supervised by an instructor in the room. Two evaluators scored video recordings of each procedure using the rubric. Participants' opinions about the simulator were collected with a survey.

RESULTS

All participants scored above the threshold (range, 126-151) and successfully completed laparoscopic ovariectomy in a live dog, with an average of 10 of 17 participants requiring verbal guidance and 5 of 17 participants requiring intervention from the instructor. Interrater concordance was excellent for the rubrics used to score performance on the simulator (R = 0.91) and in vivo (R = 0.81). All participants agreed that the simulator should be used to assess trainee readiness prior to surgery in a live dog.

CONCLUSION

Participants achieving a score of at least 126 of 160 on the simulator were able to perform a laparoscopic ovariectomy in a live dog under supervision. The scoring system for the simulator had excellent interrater concordance.

CLINICAL SIGNIFICANCE

This simulator and scoring system can be used in laparoscopic training programs to assess readiness for progression to the operative setting.

Perceptions and experience of veterinary surgery residents with minimally invasive surgery simulation training

OBJECTIVE

To determine access to and use of minimally invasive surgery (MIS) simulators among American College of Veterinary Surgeons (ACVS) small animal residents and to identify barriers to simulator use and perceptions of simulator training.

STUDY DESIGN

Voluntary online survey.

SAMPLE POPULATION

One hundred forty-one ACVS small animal residents.

METHODS

American College of Veterinary Surgeons residents were identified by contacting ACVS residency program directors. An emailed online survey was sent to residents along with a reminder email 2 weeks later. All surveys were collected within 1 month. Participation was voluntary but incentivized.

RESULTS

Response rate to the survey was 79 of 141 (56%) residents. Twenty-eight of 77 (36%) residents have access to a simulator, with box simulators being most common. Lack of time was the most frequent reason for not using the simulator more. Sixty-eight of 77 (88%) and 65 of 77 (65%) residents agreed or strongly agreed that simulator-based training improves laparoscopic skills and that simulator skills are transferable to the operating room, respectively. Residents with access to a simulator were more comfortable with basic laparoscopic surgeries at the end of their residency than those without such access (P = .04).

CONCLUSION

There is substantial room for improved access to and use of MIS simulator training in ACVS residency programs. Despite lack of simulator access, residents believed that simulator training improved their skill and comfort level with basic laparoscopic procedures.

CLINICAL SIGNIFICANCE

The results of this study inform us about access to and perceptions of MIS simulator training among residents. This information is important to surgeons responsible for training residents and may help guide the creation of a surgical skills curriculum.