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

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.

Novel 3D Custom-Made Silicone Tumor Model as a Support for Teaching Surgical Oncology Principles

Alternative laboratory teaching methods are becoming increasingly desirable and effective in medical education environments. While ethical concerns associated with the use of live animals in terminal surgery laboratories have been reduced with cadaveric models, availability, and lack of pathology can limit their ability to adequately convey surgical principles and replicate clinical training. We have developed a three-dimensional (3D) custom-made silicone soft tissue tumor model using 3D-printed molds derived from canine soft tissue sarcoma computed tomography images. This novel teaching model allows users to apply surgical oncology principles and perform basic technical tasks such as incisional biopsy, margin demarcation, marginal and wide surgical excision, and inking of surgical margins. A large cohort of students in addition to a small number of professional veterinarians at different levels of specialty training followed the laboratory guidelines and evaluated the simulated tumor model based on a qualitative survey. All participants were able to successfully complete the practical training. The model also allowed the students to identify and correct technical errors associated with biopsy sampling and margin dissection, and to understand the clinical impacts related to those errors. Face and content validity of the model were assessed using Likert-style questionnaires with overall average instructors' scores of 3.8/5 and 4.6/5, respectively. Content validity assessment of the model by the students approximated instructors' evaluation with an overall average score of 4.4/5. This model development emphasizes the efficacy of alternative non-cadaveric laboratory teaching tools and could become a valuable aid in the veterinary curricula.

Evaluation of veterinary students' confidence and competence with surgical entrustable professional activities after repeated use of low-fidelity training models

BACKGROUND

This study aimed to evaluate whether low-fidelity surgical training models increased veterinary students' surgical confidence and competence and decreased procedural stress related to core surgical entrustable professional activities (EPAs).

METHODS

Final-year veterinary students repeatedly performed one of three surgical EPAs on a low-fidelity surgical training model (canine castration, subcutaneous lump removal and eyelid laceration repair) and completed a survey at set time points. In addition, a grading rubric was used to assess participants' competence in performing the assigned EPA at two different time points. Survey results and competency gradings were compiled and analysed.

RESULTS

Students' self-assessed confidence significantly increased, and stress significantly decreased, between assessment points on all three EPA surgical training models. Graded competence significantly improved between the assessment points on all training models, and most students deemed the models to be realistic and helpful for student practices.

LIMITATIONS

Limitations relate to the study involving a single cohort from a single institute and the reliance on student self-assessment.

CONCLUSIONS

Repeated exposure to low-fidelity surgical training models increased final-year students' surgical confidence and competence and reduced procedural stress related to three key surgical EPAs. Assessment of competence using a grading rubric was successful and could be incorporated into a competence-based veterinary education assessment framework to allow screening of competence prior to graduation.

The assessment of suture spacing on the esthetic and functional outcomes of skin closures in different age groups

Background and Aims

Dermatological surgeons must master the factors affecting wound healing. Suturing is the most common method of wound closure. One of the significant factors in suturing that affects wound healing and cosmetic results is the distance between sutures, which has been studied very little to date. The aim of the current study was to investigate the effect of simple interrupted suture with a distance of 2 and 5 mm on the esthetic and functional results of suture closure in different age groups.

Methods

In patients with two skin lesions, one wound was sutured with a distance of 2 mm and the other with a distance of 5 mm, and the wounds were evaluated 1 and 3 months after the operation using the POSAS scale.

Results

Patients' opinions indicate that, in the suture intervals of 2- and 5-mm and at 1 and 3 months, the average was lower in the younger group than it was in the older group and also, as per the physician's opinion, the average in the age group under 50 years was significantly lower than that in the age group over 50 years.

Conclusions

According to the results of the present study, a suture of 2-mm and a suture of 5-mm would result in different esthetic and functional outcomes depending on the patient's age. The average in the age group less than 50 years was significantly lower than that of the age group greater than 50 years.

The Impact of the COVID-19 Pandemic on Veterinary Clinical and Professional Skills Teaching Delivery and Assessment Format

The limitations posed by the COVID-19 pandemic have been particularly challenging for courses teaching clinical and professional skills. We sought to identify how the COVID-19 pandemic has impacted the delivery of veterinary clinical and professional skills courses, including modifications to teaching and assessment, and to establish educators' perceptions of the efficacy of selected delivery methods. A branching survey was deployed to 35 veterinary schools in North America in March and April 2021. The survey collected data about curriculum and assessment in spring 2020, fall 2020, and spring 2021. Educators at 16 veterinary schools completed the survey (response rate: 46%). Educators quickly adapted curriculum to meet the requirements of their institutions and governments. Early in the pandemic (spring 2020), curriculum was delayed, delivered remotely, or canceled. Assessment methods frequently included virtual objective structured clinical examinations (OSCEs) and video-recorded skills assessments. Later in the pandemic (fall 2020, spring 2021), in-person clinical skills sessions resumed at many schools, often in smaller groups. Professional skills instruction typically remained virtual, as benefits were noted. Assessment methods began to normalize with in-person OSCEs resuming with precautions, though some schools maintained virtual assessments. Educators noted some advantages to instructional methods used during COVID, including smaller group sizes, better prepared students, better use of in-person lab time, more focus on essential course components, provision of models for at-home practice, and additional educators' remote involvement. Following the pandemic, educators should consider retaining some of these changes while pursuing further advancements, including improving virtual platforms and relevant technologies.

Validation of a Rubric Used for Skills-Based Assessment of Veterinary Students Performing Simulated Ovariohysterectomy on a Model

Surgical skills are an important competency for new graduates. Simulators offer a means to train and assess veterinary students prior to their first surgical performance. A simulated ovariohysterectomy (OVH) rubric's validity was evaluated using a framework of content evidence, internal structure evidence, and evidence of relationship with other variables, specifically subsequent live surgical performance. Clinically experienced veterinarians (n = 13) evaluated the utility of each rubric item to collect evidence; each item's content validity index was calculated to determine its inclusion in the final rubric. After skills training, veterinary students (n = 57) were assessed using the OVH model rubric in March and August. Internal structure evidence was collected by video-recording 14 students' mock surgeries, each assessed by all five raters to calculate inter-rater reliability. Relationship with other variables evidence was collected by assessing 22 students performing their first live canine OVH in November. Experienced veterinarians included 22 items in the final rubric. The rubric generated scores with good to excellent internal consistency; inter-rater reliability was fair. Students' performance on the March model assessment was moderately correlated with their live surgical performance (ρ = 0.43) and moderately negatively correlated with their live surgical time (ρ = -0.42). Students' performance on the August model assessment, after a summer without surgical skills practice, was weakly correlated with their live surgical performance (ρ = 0.17). These data support validation of the simulated OVH rubric. The continued development of validated assessment instruments is critical as veterinary medicine seeks to become competency based.

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.

A utilização de simuladores para o ensino da punção de agulha fina em medicina veterinária

A punção de agulha fina (PAF) é amplamente utilizada por veterinários, sendo ensinada maioritariamente por observação. Atualmente, considera-se que a utilização de simuladores melhora a aprendizagem de procedimentos práticos. No entanto, simuladores de PAF ainda não foram avaliados em Medicina Veterinária. Cinquenta e um estudantes de Veterinária sem experiência prévia em Citologia foram distribuídos aleatoriamente em dois grupos que usaram um simulador (caixa com nódulos artificiais) e uma peça de fruta (banana). Foi utilizado um desenho de aula invertida com estações: primeiramente, os estudantes observaram um vídeo tutorial sobre a PAF, utilizando em seguida o simulador ou a peça de fruta durante um máximo de 15 minutos. Depois, os estudantes efetuaram o procedimento num modelo animal realista, realizando-se uma avaliação clínica objetiva estruturada (ACOE). A aprendizagem através dos modelos foi comparada por meio de questionários, taxa de aprovação em ACOE e qualidade dos esfregaços obtidos. Após observar o vídeo tutorial, nenhum estudante manifestou ser capaz de fazer a PAF num animal vivo. Por oposição, a maioria revelou ser capaz após a simulação. Os estudantes praticaram mais tempo na caixa (14,8 ± 0,8 min) do que na peça de fruta (8,5 ± 2,2 min). Na avaliação, os primeiros tinham maior precisão na PAF. Ainda assim, não existiram diferenças na taxa de aprovação em ACOE. Portanto, os dois modelos são eficazes para a aprendizagem da PAF, mas a caixa tem vantagens quanto à repetição autónoma da prática. Essa repetição parece ter efeitos positivos na precisão da PAF, o que tem relevância do ponto de vista clínico.

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.