Development and Evaluation of Two Canine Low-Fidelity Simulation Models

Development of a virtual reality simulator for training canine endotracheal intubation technique and evaluation of the educational impacts

Virtual reality (VR)-based training has shown some benefits in medical education, supporting skill acquisition, and helping reduce anxiety in real-world settings. However, the use of VR simulators in veterinary education remains limited. This study aimed to introduce a VR simulator to support veterinarian training in canine anaesthesia induction and endotracheal intubation. This study involved a group that learned solely with instructional videos (video group), and one that learned concurrently with the video and VR simulator (VR group). Third- and fourth-year veterinary students were included and underwent a descriptive test on canine endotracheal intubation. Canine endotracheal intubation success rates were compared between the video (n = 364) and VR (n = 60) groups of fifth-year students. A survey on the VR usability was conducted (n=91). The median descriptive test scores improved in the VR (63.3/100) vs the video group (51.5/100). The canine intubation success rates were comparable in the VR and video groups at 84.3 % and 77.4 %, respectively. A total of 90.1 % of the surveyed students rated the ease of use of the simulator highly. Overall, VR simulators were well-received, suggesting benefits in new skill retention. Further studies are required to evaluate the extent of skill improvement through VR-based training, compared to conventional methods, and to assess its impact on student motivation. Evaluating the long-term effects of VR-based training on skill development and retention will also provide a deeper understanding of its educational benefits.

Feasibility and acceptance of ready-made standard operating procedures in calf care on German dairy farms

Calf loss continues to be a considerable problem on German dairy farms. Untrained personnel or the lack of best practice routines are potential reasons. Standard operating procedures (SOPs) may increase process consistency and can improve animal health and animal welfare. We developed SOPs for 8 important tasks in calf care and provided them online to interested dairy farmers and their employees. Five questionnaires were embedded to collect data on demographics, use, perception, and feasibility of SOPs. Main objectives of the study were to investigate 1) if there is a gap between the existence of SOPs and the wish for SOPs, 2) if participants (n = 301) consider ready-made SOPs as feasible for their farm and 3) suitable to train new personnel, and 4) if they state their confidence in task execution higher after the courses. We experienced a strong discrepancy between the existence (13.1%) and the wish for SOPs (69.4%). Most the participants rated ready-made SOPs as feasible for their farm (66.5%). Eighty-five percent fully agreed or agreed to the statement that SOPs are a suitable tool for training new employees. Interestingly, 64.2% of employees mentioned, that they wanted to be involved in the creation of SOPs specific to their farm. The SOP based e-learning courses increased the confidence in performing tasks in calf care, especially concerning the tasks which were less often performed tasks such as tube feeding, emergency care and testing of colostrum quality.

Comparing the Efficacy of a New Clinical Skills Model with a Traditional Method to Teach Tube Feeding of an Avian Patient

Interactive clinical skills models have been demonstrated to be useful for teaching medical and veterinary clinical skills, yet to date, very few exist for teaching skills relevant to zoological companion animals and wildlife species including birds. This two-part study aimed to create, develop, and validate a model. Interviews and a survey were conducted using veterinary and wildlife professionals to select an avian clinical skill that is challenging and performed frequently. Tube/gavage feeding, or "crop tubing" satisfied both criteria; on average it was performed 71 times a year by surveyed respondents was rated 3.4/9 for difficulty of teaching and 3.5/9 for difficulty of learning. Therefore, a new model of a bird, made from a soft toy, silicone, and 3D printed parts, was designed to train students to perform this technique. Forty-two participants were recruited and divided into two groups; one used the model the other watched an instructional video on crop tubing. The students completed a self-evaluated confidence questionnaire, before and after, using either resource. They then performed the technique on a dead bird and their proficiency at 10 different actions that comprised the technique was evaluated by two assessors. The model group performed significantly better than the video group on all evaluated actions (U ≤ 143.5, p ≤ .0031), and reported significantly higher confidence (U = 129.5, p = 0.018). In conclusion, the newly developed model in combination with an instruction booklet offers an effective and inexpensive alternative way to teach crop tubing in a teaching environment, without compromising animal welfare.

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.

Evaluating validity evidence for 2 instruments developed to assess students' surgical skills in a simulated environment

Objective

To gather and evaluate validity evidence in the form of content and reliability of scores produced by 2 surgical skills assessment instruments, 1) a checklist, and 2) a modified form of the Objective Structured Assessment of Technical Skills (OSATS) global rating scale (GRS).

Study design

Prospective randomized blinded study.

Sample population

Veterinary surgical skills educators (n =10) evaluated content validity. Scores from students in their third preclinical year of veterinary school (n = 16) were used to assess reliability.

Methods

Content validity was assessed using Lawshe's method to calculate the Content Validity Index (CVI) for the checklist and modified OSATS GRS. The importance and relevance of each item was determined in relation to skills needed to successfully perform supervised surgical procedures. The reliability of scores produced by both instruments was determined using generalizability (G) theory.

Results

Based on the results of the content validation, 39 of 40 checklist items were included. The 39‐item checklist CVI was 0.81. One of the 6 OSATS GRS items was included. The 1‐item GRS CVI was 0.80. The G‐coefficients for the 40‐item checklist and 6‐item GRS were 0.85 and 0.79, respectively.

Conclusion

Content validity was very good for the 39‐item checklist and good for the 1‐item OSATS GRS. The reliability of scores from both instruments was acceptable for a moderate stakes examination.

Impact

These results provide evidence to support the use of the checklist described and a modified 1‐item OSAT GRS in moderate stakes examinations when evaluating preclinical third‐year veterinary students' technical surgical skills on low‐fidelity models.

Comparative Effectiveness of Training with Simulators Versus Traditional Instruction in Veterinary Education: Meta-Analysis and Systematic Review

One of the greatest challenges in veterinary education is adequately preparing students with the clinical skills they need to be successful health care providers. Integration of simulators, devices used to represent real world phenomena under test conditions, into the veterinary curriculum can help address challenges to clinical instruction. The use of simulators in veterinary education is increasing; however, their effectiveness remains unclear. This meta-analysis seeks to synthesize the evidence for simulator training in veterinary education to provide a consensus of effect, guide the integration of simulators into the curriculum, and direct the development of future simulation-based research in veterinary medicine. A systematic search identified 416 potential manuscripts from which 60 articles were included after application of inclusion criteria. Information was extracted from 71 independent experiments. The overall weighted mean effect size for simulator training was g = 0.49 for the random-effects model. The outcome measures of knowledge, time, process, and product all produced statistically significant mean effect sizes favoring simulation (d = 0.41, 0.35, 0.70, 0.53, respectively). A moderator analysis revealed that study characteristics and instructional design features moderated the effectiveness of simulator training. Overall, the results indicate that simulator training in veterinary education can be effective for knowledge and clinical skill outcomes.

Anatomical Evaluation of Rat and Mouse Simulators for Laboratory Animal Science Courses

Simple Summary

Over the past decades simulators of rats and mice have been developed as initial training devices for prospective researchers involved in animal testing. By using these simulators, different techniques such as blood sampling can be be learned prior to working on live animals. As this has the potential to minimize stress and suffering of experimental animals, the use of simulators is demanded by European law. Nevertheless, only little is known about frequency of their use, their anatomical correctness and learning efficiency. With this in mind, a collaborative research project named “SimulRATor” was initiated to systematically evaluate existing rat and mouse simulators. Results will serve as the basis for the development of a new 3D-printed rat simulator with realistic anatomy. In the subproject presented here, simulators were evaluated by experts of the field in order to analyze their anatomical strengths and weaknesses. The evaluation showed, that the limbs and especially the heads were perceived as anatomically unrealistic. Therefore, the authors will focus on these body regions during the construction process by e.g. including movable limbs, and a lower jaw with a tongue. This might positively affect the learning process and outcome and thereby support animal welfare.

Abstract

According to the European Directive 63/2010/EU, education and training involving living rats and mice are classified as an animal experiment and demands the implementation of the 3Rs. Therefore, as a method of refinement, rat and mouse simulators were developed to serve as an initial training device for various techniques, prior to working on living animals. Nevertheless, little is known about the implementation, anatomical correctness, learning efficiency and practical suitability of these simulators. With this in mind, a collaborative research project called “SimulRATor” was initiated to systematically evaluate the existing rat and mouse simulators in a multi-perspective approach. The objective of the study presented here was to identify the anatomical strengths and weaknesses of the available rat and mouse simulators and to determine anatomical requirements for a new anatomically correct rat simulator, specifically adapted to the needs of Laboratory Animal Science (LAS) training courses. Consequently, experts of Veterinary Anatomy and LAS evaluated the anatomy of all currently available rat and mouse simulators. The evaluation showed that compared to the anatomy of living rats and mice, the tails were perceived as the most anatomically realistic body part, followed by the general exterior and the limbs. The heads were rated as the least favored body part.

Educational Research Report Comparison of Three Canine Models for Teaching Veterinary Dental Cleaning

Veterinary dental cleaning prevents and treats periodontal disease, one of the most common diagnoses in small animal practice. Students learn to perform dental cleaning through deliberate practice, which can be gained through working on models. This study compared educational outcomes after students (n = 36) were randomized to practice on one of three dental cleaning models: a low-fidelity ceramic tile, a mid-fidelity three-dimensional (3D) printed canine skull model, or a high-fidelity canine head model. Students provided survey feedback about their model and later performed a dental cleaning on a canine cadaver head while being video-recorded. Experts (n = 10) provided feedback on each model. Experts agreed that all models were suitable for teaching dental cleaning, but the 3D skull and full head models were more suitable for assessing student skill (p = .002). Students were also more positive about the realism and features of those two models compared to the tile model. Students practicing on each of the models were equally effective at removing calculus from the cadavers' teeth. Students who learned on the tile model were a median of 4 minutes slower to remove calculus from their cadaver's teeth than students who trained on the canine head model. Although students may be more accepting of the 3D skull and full head models, all three models were equally effective at teaching the skill. Experts approved all models for teaching, but recommended the 3D skull or full head model if student skills were to be assessed. Low-fidelity models remain effective training tools with comparable learning outcomes.

Comparison of Self-Directed and Instructor-Led Practice Sessions for Teaching Clinical Skills in Food Animal Reproductive Medicine

While the use of simulator-based clinical skill training has become increasingly popular in veterinary education in recent years, little research has been done regarding optimal implementation of such tools to maximize student learning in veterinary curricula. The objective of this study was to compare the effects of supervised and unsupervised deliberate practice on clinical skills development in veterinary medicine students. A total of 150 veterinary students took part in instructor-led practice (supervised) or self-directed practice (unsupervised) at a selection of four learning stations in a veterinary skills laboratory. Each learning station consisted of a teaching simulator, materials required to complete the task, and a standard operating procedure detailing how to execute the task. Students used Likert scales to self-evaluate their clinical skills before and after practice sessions, in addition to evaluating their motivation to practice a given task. An objective structured clinical examination (OSCE) was used to compare participants' clinical skills performance between learning stations. We were able to show that practice had a significant positive effect on OSCE scores at three out of six available learning stations. Motivation ratings varied between learning stations and were positively correlated with an increase in self-perceived clinical skills. At an instructor-to-student ratio of approximately 1:8, supervision had no effect on OSCE scores at four out of six learning stations. At the remaining two learning stations, self-directed practice resulted in better learning outcomes than instructor-led practice.

The influence of low-fidelity simulator training on canine peripheral venous puncture procedure

Background and Aim:

Blood collection from dogs is the most commonly performed procedure in the medical clinic. However, different factors can interfere with the quality of the material collected, potentially causing complications for patients. Simulated skill training is a teaching strategy designed to provide early training to students, develop their skills and self-confidence, and increase the procedure’s success while reducing complications. Therefore, the aim of this study was to evaluate skill training using a low-fidelity simulator in the peripheral venipuncture procedure and examine the training’s influence on the in vivo procedure.

Materials and Methods:

To assess skill training, this study used a low-fidelity simulator in the peripheral venipuncture procedure and examines the training’s effect on the in vivo procedure. In total, 100 dogs, 65 undergraduate students, 3 veterinarians, and 4 previously trained evaluators participated. The canine in vivo venipuncture procedure was evaluated both before and after the simulated skill training and the low-fidelity simulator training. Data were collected on participants’ self-confidence levels.

Results:

Local complications occurred during in vivo practice; however, after training, they decreased. Gloves were more frequently used during the procedure, resulting in a reduction of both harvest attempts and complications, as well as increased levels of self-confidence in post-training participants. The simulator developed had low fidelity, low cost, and was easy to create.

Conclusion:

Skill training in peripheral venipuncture using a low-fidelity simulator positively influences student learning, increases their self-confidence during in vivo harvesting, and reduces the complications of the procedure, improving patient well-being.

Simulated Clinical Skills for Veterinary Students Supplement Limited Animal and Clinical Resources in Developing Countries

As part of an OIE Veterinary Education Twinning Project linking The University of Queensland, Australia and Nong Lam University, Vietnam, the limited access to animal and clinical resources was identified as an impediment to high quality veterinary education at Nong Lam University. However, student focused, simulated learning spaces, which have been widely adopted in veterinary training, are a cost-effective opportunity to provide initial clinical skills to students in countries where resourcing is constrained. In clinical skills training facilities, students use models and simulators to practice their clinical skills to develop the confidence, competence and muscle memory to enter the clinical phase of their training. While high-fidelity veterinary simulators and models are expensive, effective models for foundational clinical skills development can be built in-house for students to practice their skills authentically. This article outlines the cost effective establishment of a veterinary clinical skills training facility at Nong Lam University.

Comparison of a Silicon Skin Pad and a Tea Towel as Models for Learning a Simple Interrupted Suture

There has been rapid growth in the range of models available for teaching veterinary clinical skills. To promote further uptake, particularly in lower-income settings and for students to practice at home, factors to consider include cost, availability of materials and ease of construction of the model. Two models were developed to teach suturing: a silicon skin pad, and a tea towel (with a check pattern) folded and stapled to represent an incision. The models were reviewed by seven veterinarians, all of whom considered both suitable for teaching, with silicon rated as more realistic. The learning outcome of each model was compared after students trained to perform a simple interrupted suture. Thirty-two second-year veterinary students with no prior suturing experience were randomly assigned to three training groups: silicon skin pad or tea towel (both self-directed with an instruction booklet), or watching a video. Following training, all students undertook an Objective Structured Clinical Examination (OSCE), placing a simple interrupted suture in piglet cadaver skin. The OSCE pass rates of the three groups were silicon skin pad, 10/11; tea towel, 9/10; and video, 1/11. There was no significant difference between the model groups, but the model groups were significantly different from the video group (p < .017). In conclusion, the tea towel was as effective as the silicon skin pad, but it was cheaper, simpler to make, and the materials were more readily available. In addition, both models were used effectively with an instruction booklet illustrating the value of self-directed learning to complement taught classes.

Effect of Instructional Format on Veterinary Students' Task Performance and Emotional State during a Simulation-Based Canine Endotracheal Intubation Laboratory: Handout versus Video

Video- versus handout-based instructions may influence student outcomes during simulation training and competency-based assessments. Forty-five third-year veterinary students voluntarily participated in a simulation module on canine endotracheal intubation. A prospective, randomized, double-blinded study investigated the impact of video (n = 23) versus handout (n = 22) instructions on student confidence, anxiety, and task performance. Students self-scored their confidence and anxiety before and after the simulation. During the simulation laboratory, three raters independently evaluated student performance using a 20-item formal assessment tool with a 5-point global rating scale. No significant between- or within-group differences (p > .05) were found for both confidence and anxiety scores. Video-based instructions were associated with significantly higher (p < .05) total formal assessment scores compared with handout-based instructions. The video group had significantly higher scores than the handout group on 3 of the 20 individual skills (items) assessed: placement of tie to the adaptor-endotracheal tube complex (p < .05), using the anesthetic machine (p < .01), and pop-off valve management (p < .001). Inter-rater reliability as assessed by Cronbach's α (.92), and Kendall's W (.89) was excellent and almost perfect, respectively. A two-faceted crossed-design generalizability analysis yielded G coefficients for both the handout (E_p² = .68) and the video (E_p² = .72) groups. Video instructions may be associated with higher performance scores than handout instructions during endotracheal intubation simulation training. Further research into skill retention and learning styles is warranted.

Challenges & Issues: Evidence-Based Clinical Skills Teaching and Learning: What Do We Really Know?

The recent programmatic focus on skills development in veterinary medicine means that many programs are devoting increased time to formal clinical skills teaching. This expansion makes it essential that we use the time as effectively as possible. This review examines current practices and veterinary training principles using the broader field of evidence-based motor skills learning as a lens. In many areas, current practices may be hindering learning. Proposed practices include using videos and discussions for pre-laboratory training, focusing on a single complex skill at a time, using more near-peer instructors rather than faculty, including assessments in each teaching or practice session, and encouraging supervised distributed practice by incorporating practice sessions into the formal curriculum. Ensuring mastery of a few core skills rather than exposure to many may be the new goal. Further research is urgently needed on block versus spiral curricula, optimum instructor-to-student ratios, learning and practice schedules, hours required for proficiency, and the benefits of exercise on motor skills learning.

Does Studying Veterinary Medicine Improve Students' Haptic Perception Ability? A Pilot Study With Two Age-Groups

Haptic perception is an important tool for veterinarians. The present study analyzed the association between the haptic perception threshold of veterinary students and their palpatory experience. To approach this goal, 35 female students of veterinary medicine were divided into two groups with different levels of experience: (a) students with little practical experience, at the beginning of their studies (first year), and (b) students close to the end of their theoretical training (fourth year). To thoroughly evaluate the students' sense of touch, three different test procedures were used: the Haptic Threshold Test (HTT), the Haptic Figures Test (HFT), and tactile acuity. Contrary to our expectations, we found worse mean haptic perception thresholds (HTT) in the more experienced students than in the less experienced group. This effect was significantly correlated with age. Furthermore, we found that longer exploration times were not sufficient to compensate for shortcomings in haptic perception. We also found large interindividual differences. Future studies should investigate whether and to what extend these effects have an impact on students' palpation performance on simulators and live animals. Moreover, which beneficial effects may be achieved through an additional haptic training for students with inferior haptic thresholds should be investigated. Improving haptic perception abilities in veterinary students could be one important step toward achieving satisfactory Day One Competences in university graduates.

Development and Student Evaluation of an Anatomically Correct High-Fidelity Calf Leg Model

Obstetrical chain placement requires location of specific landmarks and a certain dexterity that must be practiced. Use of low-fidelity models may not always provide students with a realistic experience. In this study we developed an anatomically correct high-fidelity calf leg model that would serve as a better teaching model for pre-clinical veterinary students than a pre-existing low-fidelity polyvinyl chloride (PVC) model. One hundred and twenty pre-clinical veterinary students were instructed how to use obstetrical chains with a low-fidelity PVC model and the anatomically correct high-fidelity calf leg model. After a 45-minute lab, students were surveyed on their experience with both models. Overall students felt the anatomically correct high-fidelity calf leg model increased accuracy in chain placement and provided more accurate landmarks, a more realistic model, and more real-life scenario training.

A Survey of Established Veterinary Clinical Skills Laboratories from Europe and North America: Present Practices and Recent Developments

Developing competence in clinical skills is important if graduates are to provide entry-level care, but it is dependent on having had sufficient hands-on practice. Clinical skills laboratories provide opportunities for students to learn on simulators and models in a safe environment and to supplement training with animals. Interest in facilities for developing veterinary clinical skills has increased in recent years as many veterinary colleges face challenges in training their students with traditional methods alone. For the present study, we designed a survey to gather information from established veterinary clinical skills laboratories with the aim of assisting others considering opening or expanding their own facility. Data were collated from 16 veterinary colleges in North America and Europe about the uses of their laboratory, the building and associated facilities, and the staffing, budgets, equipment, and supporting learning resources. The findings indicated that having a dedicated veterinary clinical skills laboratory is a relatively new initiative and that colleges have adopted a range of approaches to implementing and running the laboratory, teaching, and assessments. Major strengths were the motivation and positive characteristics of the staff involved, providing open access and supporting self-directed learning. However, respondents widely recognized the increasing demands placed on the facility to provide more space, equipment, and staff. There is no doubt that veterinary clinical skills laboratories are on the increase and provide opportunities to enhance student learning, complement traditional training, and benefit animal welfare.