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

SimuVet: a preliminary study of the innovative development of a simulator for epidural anesthesia training in dogs

Epidural anesthesia in dogs is a locoregional anesthesia technique used in veterinary medicine, becoming an important integrated application in the anesthetic protocol to provide safer and more effective analgesia to patients. For this, professionals must adhere to rigorous guidelines and possess technical skills. In this context, in veterinary education, the development of practical clinical skills represents a crucial aspect in the training of these professionals. However, traditional teaching methods have proven insufficient to ensure a consistent level of competence among recent graduates. The introduction of non-animal alternatives for educational purposes has contributed to the development of simulation-based teaching, an innovative and accessible field capable of enhancing pre-clinical proficiency in students and reducing the use of live animals and cadavers. Despite its application in various areas of veterinary education, there are no conclusive results regarding the development of accessible simulators capable of effectively enhancing training in epidural anesthesia in dogs. Therefore, this article represents a pioneering study aimed at sharing a method for creating SimuVet, a realistic simulator for training epidural anesthesia in dogs. The simulator was fully developed by veterinary researchers with limited experience in 3D printing and, after preliminary analysis, demonstrated excellent performance and ultrasonographic anatomy. Future work will focus on the formal validation of this simulator with the aim of improving the teaching and learning process for students and experts in performing epidural anesthesia in companion animals.

A 3D-Printed Dummy for Training Distal Phalanx Amputation in Mice

The development of realistic dummies for training the distal phalanx amputation (DPA) technique in mouse pups is a promising alternative to reduce and replace animals in training for research and teaching. To test this, we obtained micro-CT data from postnatal day-five mouse pups, meticulously segmented them, and converted them into a 3D mesh format suitable for 3D printing. Once the dummy was printed, it was evaluated during actual training courses in two different groups: in the first group, users received no dummies to train the DPA, and in the second group, users were trained with three dummies. To assess the effectiveness of the dummy, we conducted a survey followed by an expert veterinarian evaluation. Our results showed that DPA is a complex procedure, and it is commonly poorly performed. When implementing the dummies, users who were not provided with dummies to practice only had an 8.3% success rate in DPA, while users provided with three dummies had a 45.5% success rate, respectively. Despite additional research being needed, our dummy offered improved practical training by providing a safe and effective alternative in line with ethical considerations while demonstrating the feasibility of using 3D printing technology to promote the 3Rs in experimental research.

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.

An immersive simulation strategy to teach cytology sample collection methods and basic diagnosis skills: A two academic center study

BACKGROUND

Collecting cytology samples and making simple diagnoses are skills taught in veterinary universities, mostly in a passive way. Simulators enhance practical skills learning, increasing student engagement through immersive activities. These strategies have not been carefully assessed in veterinary cytology.

OBJECTIVES

This study aimed to describe a simulator developed for training cytology sample collection methods and assess the utility of an immersive simulation strategy to learn and practice the collection of cytology samples.

METHODS

A flipped classroom with a station design was followed. Students first watched video tutorials on sampling collection, listened to brief cases' clinical histories, and moved to immersive simulator stations. There, they practiced imprints, swabs, and fine-needle aspiration (FNA). Microscopic observation of the material was available through augmented reality tools. Students were evaluated by Objective Structured Clinical Examination (OSCE) tools on their ability to perform FNA on stuffed animal models. Students answered two questionnaires addressing their learning outcomes.

RESULTS

Second- and third-year students from two centers (n = 129) practiced cytologic collection methods in simulators which significantly changed their willingness to perform FNA in live animals after the class activities. OSCE pass rates over 90% were obtained for most steps of FNA, and students rated the activity as essential/very relevant for learning.

CONCLUSIONS

Immersive simulation strategies were effective at increasing student comfort with cytologic sampling techniques. This approach should be included in the veterinary curriculum as it can increase the quality of cytology samples and could potentially improve the cytologic diagnosis of a submitted sample.

An immersive simulation strategy to teach canine vaginal cytology: A multi-centre study

Vaginal cytology (VC) is an essential technique for monitoring the bitch's estrus cycle. Currently, animal-free teaching methodologies have not been investigated for VC. Hence, this study aimed to evaluate an immersive simulation with a VC model and augmented reality tools. Students (n = 219) from four universities were enrolled, having learning stations with models for practising VC that provided immediate feedback on the technique. Augmented reality tools comprised QR codes that endorsed students to short videos of owners' avatars reporting the clinical reproductive story of the simulated animals and slides with QR codes leading to microscopy slide navigation videos. Proestrus, estrus, diestrus, anestrus and vaginitis were identified in the learning stations. The students' perceptions were evaluated through questionnaires assessing satisfaction, motivation, confidence, impact on learning and diagnostic accuracy. Before the immersive simulation, students had no experience with VC, being afraid of doing a VC with a live dog. Almost all the students considered practicing VC as essential and 94% reported that repeating the procedure (>2 times) was the most important parameter for learning. The simulation activity lasted ≈3 h and significantly improved the confidence of students, being less afraid of doing a VC in a live animal. Slide navigation videos improved the diagnostic accuracy of the estrus cycle stage, and students diagnosed the estrus and vaginitis cases more accurately. The immersive simulation strategy allowed repeated practice in a safe, motivated and standardized environment, being appraised by students as an essential strategy for learning VC.

Development and Validation of a Simulation Model for Collection of Canine Vaginal Samples

Vaginal cytology is a widely used cytological technique mostly taught by observation, either through direct tutoring or videos. To the best of our knowledge, vaginal cytology simulators have never been assessed in veterinary medicine. Twenty-five undergraduate students with no prior experience in canine vaginal sampling were randomly assigned to two groups that either practiced the procedure in a simulator or a live animal. An inverted classroom design was followed. After observing a video tutorial, students practiced with the simulator/live animal for two classes. Three weeks later, they performed a vaginal cytology on a live animal being recorded. The videos were evaluated through an objective structured clinical examination (OSCE) by an observer blinded to the student's groups. The learning outcome was compared through OSCE pass rates and questionnaires. The simulation model was made by 3D printing and soft silicone for the vulvar labia, having pink and blue colored vaseline in the correct and incorrect locations for sampling. The model was economic and accurately replicated the female reproductive tract. It provided immediate feedback to students, by obtaining pink or blue swabs from the correct and incorrect locations, respectively. Students reported that three to five or more attempts were needed to properly learn the procedure, thus justifying the need for a simulator. No differences in the OSCE pass rates were observed between the groups. The simulation model was effective for learning the vaginal cytology procedure, replacing the use of live animals. This low-cost model should be incorporated in the tool-kit of reproduction classes.

Evaluation of an Equine Nasogastric Intubation Model for Training Veterinary Students

Simulation in veterinary education is an important means of providing a safe, welfare-friendly way for students to hone their skills prior to performing procedures on live animals. Students may not get many chances to practice passing a nasogastric tube and checking for reflux in live horses during clinical rotations and extra-mural studies. A low-cost equine nasogastric intubation model was created at the University of Surrey, allowing students to practice passing a tube and checking for reflux. Thirty-two equine veterinarians evaluated the model for realism, and its potential usefulness in teaching. Veterinarians found the model to be realistic, supported its use as a teaching aid, and provided helpful feedback for possible improvements. In addition, 83 year 4 veterinary students rated their level of confidence before and after using the model for nine specific aspects of nasogastric intubation. Students showed significantly increased confidence levels in all nine aspects after using the model, and reported that they appreciated being able to practice the skill in a safe environment prior to performing it on a live horse. The results of this study suggest that both clinicians and students considered that this model has educational value, which supports its use for training veterinary students prior to clinical placements. The model provides an affordable, robust educational aid that can be used in clinical skills teaching, increases student confidence, and allows students to practice the skill repeatedly.

The Rapid and International Expansion of Veterinary Clinical Skills Laboratories: A Survey to Establish Recent Developments

Veterinary clinical skills laboratories are used for teaching a wide range of practical, clinical, and surgical skills on models and simulators. A survey conducted in 2015 identified the role of such facilities in veterinary education in North America and Europe. The current study aimed to capture recent changes using a similar survey with three sections to collect data about the structure of the facility, its uses in teaching and assessment, and the staffing. The survey consisted of multiple choice and free text questions, was administered online using Qualtrics and was disseminated in 2021 via clinical skills networks and Associate Deans. Responses were received from 91 veterinary colleges in 34 countries; 68 had an existing clinical skills laboratory and 23 were planning to open one within 1-2 years. Collated information from the quantitative data described the facility, teaching, assessment and staffing. Major themes emerged from the qualitative data relating to aspects of the layout, location, integration in the curriculum, contributions to student learning, and the team managing and supporting the facility. Challenges were associated with budgeting, the ongoing need for expansion and leadership of the program. In summary, veterinary clinical skills laboratories are increasingly common around the world and the contributions to student learning and animal welfare were well recognized. The information about existing and planned laboratories and the tips from those managing the facilities provides valuable guidance for anyone intending to open or expand an existing clinical skills laboratory.

Watching me … watching you: Training and assessment in a virtual world

Virtual education isn't new. Teaching has been delivered remotely for many years, although it came to prominence with the enforced move to online learning during the COVID-19 pandemic. Technologies provide tools that are integral to our everyday lives, and training and assessment are no different. Stepping back from the obligatory remote delivery of practical skills training, now we have the opportunity to review and evaluate our own learning (as educators) about the value of resources for training delivery. Combining sound educational principles with the available technologies, we can use remotely delivered learning to enhance our teaching and to increase access to learning, without hindrance because of distance or the type of facility. Remote connections allow expertise and best practice to become suddenly available to a wider cohort of researchers, rapidly spreading new ideas about refinement of in vivo procedures and supporting colleagues to learn and develop. We currently use only a few of the technological tools available, and there is much to learn from other disciplines where virtual and augmented reality are assisting surgeons, aircraft pilots and others daily. By harnessing remote and assisted technologies in teaching, we can also develop the mindset and ability of the biomedical community to use them to augment, or even to replace, animal studies in future and to democratise training globally.

Efficacy validation of a low-cost handmade simulator (SIMCA-COW) in palpation, ultrasonography evaluation, and artificial insemination in cows

Background and Aim

Using simulators in high education enables practical training by repetition in circumstances close to reality reducing the stress of both animal and operator. The limited resources of veterinary schools, the increase in the number of students in lecture halls, and the low availability of animals for teaching due to welfare regulations, reduce teaching opportunities with live animals being simulator as the better alternative. This study aimed to assess the efficacy of a low-cost handmade simulator (SIMCA-COW) in eight veterinary students inexperienced in palpation, ultrasonography evaluation, and artificial insemination in cows.

Materials and Methods

Two sets of exercises were carried out: structure localization by rectal palpation and ultrasonography were evaluated by the inexpert veterinary students in the SIMCA-COW simulator. Also, evaluated the length of time to insert the insemination catheter through the cervix in the inert simulator during four sessions.

Results

All the students were able to palpate both structures and to locate the body and both uterine horns by ultrasonography. Cervix and follicles were located by 5/8 (62.5%) students and 3/8 (37.5%) students found the corpus luteum by ultrasonography. A reduction in time span between the first and fourth intrauterine insemination attempts was observed (8.26 ± 2.7 vs. 3.69 ± 1.7; mean ± standard error; p < 0.05).

Conclusion

The simulator validated in this study (SIMCA-COW) allows training and learning by repetition, saving the limitations found in live animal practice.