New Training Options for Minimally Invasive Surgery Skills

Veterinary minimally invasive surgery (MIS) training options are becoming more available. This article reviews new developments in this area and the current evidence for manual skills and cognitive training of MIS.

Using Creativity as an Educational Tool in Veterinary Surgery: Students' Perceptions and Surgical Performance

With the aim of improving students' ability to handle the complexity of surgery, we introduced a creative assignment in a veterinary surgical course. We hypothesized that by using this active, inductive educational method, reflection, creativity and self-efficacy in student novice surgeons could be improved. During a companion animal surgical course an intervention group was investigated against a control group. Twenty-nine fourth-year students were instructed in ovariohysterectomy by classical lectures, while 23 fourth-year students were provided with creative materials and assigned to consider and illustrate how to perform the procedure themselves. Surgical performance was assessed for both groups using a modified Objective Structured Assessment of Technical Skills (OSATS) while performing a simulated ovariohysterectomy. Furthermore, both groups were investigated with respect to how they would handle a specific hypothetical surgical complication. Semi-structured interviews were conducted with 17 intervention-group students and were analyzed using thematic analysis. The intervention group showed a significantly better performance and needed significantly less help with the surgical complication than the control group students. Data from interviews furthermore demonstrated that students believed the creative intervention produced increased reflection, more creative initiatives, and a feeling of security before surgery. Our study results thus indicate that an educational tool which stimulates creative thinking can promote reflection, creativity, and self-efficacy in novice surgeons without compromising surgical performance.

Guidelines for Implementing a Low-Cost Volunteer Desexing Skills Training Program for Veterinary and Veterinary Technology Students

Although desexing surgeries are considered a core clinical skill for small animal veterinary practice, it can be challenging for veterinary schools to provide students with adequate training opportunities in the traditional curriculum. At the Massey University School of Veterinary Science, we recently established an innovative extracurricular volunteer program designed to have students teaching other students how to perform different elements of desexing procedures as they progress through their degree. This program includes administrative and assistant roles for first-year students (responsible for client communication, patient restraint, and medical record keeping), physical exam and recovery roles for second-year students (responsible for assessing patient fitness for surgery, drawing up anesthetic drugs, and monitoring patients in recovery), anesthesia and neuter surgeon roles for third-year students (responsible for inducing, preparing, and monitoring spay patients and performing cat neuter surgeries), and spay surgeon roles for fourth- and fifth-year students (responsible for performing cat spay surgeries, discharging patients, and following up with clients to monitor recovery). This program has been successful in improving student confidence and competence while also providing a valuable low-cost desexing service to the community. In this article, we discuss the practical considerations and processes involved in implementing this program, including mapping the existing surgical curriculum, recruiting patients, setting up the surgical facilities, purchasing equipment and supplies, establishing standard operating procedures, developing training materials, maintaining clinic records, and monitoring program outcomes. These resources can serve as guidelines for other veterinary schools looking to expand desexing surgery training opportunities for students.

The Effect of an Ovariohysterectomy Model Practice on Surgical Times for Final-Year Veterinary Students' First Live-Animal Ovariohysterectomies

This study evaluated whether one supervised simulated ovariohysterectomy (OVH) using a locally developed canine OVH model, decreased surgical time for final-year veterinary students' first live-animal OVH. We also investigated student perceptions of the model as a teaching aid. Final-year veterinary students were exposed to an OVH model (Group M, n = 48) and compared to students without the exposure (Group C, n = 58). Both groups were instructed similarly on performing an OVH using a lecture, student notes, a video, and a demonstration OVH performed by a veterinary surgeon. Students in Group M then performed an OVH on the model before performing a live-animal OVH. Students in Group C had no exposure to the OVH model before performing a live-animal OVH. Surgical time data were analyzed using linear regression. Students in Group M completed a questionnaire on the OVH model after performing their first live-animal OVH. The OVH model exposure reduced students' first canine live-animal OVH surgery time (p = .009) for students without prior OVH experience. All students (n = 48) enjoyed performing the procedure on the mode; students practicing an OVH on the model felt more confident (92%) and less stressed (73%) when performing their first live-animal OVH. Results suggest that the canine OVH model may be helpful as a clinical training tool and we concluded that the OVH model was effective at decreasing students' first OVH surgical time.

Suture length to wound length ratio for simple continuous abdominal closures in veterinary surgery: An experimental in vitro study

Objective

This study aimed to investigate the suture length to wound length ratio (SL:WL) in an in vitro model of abdominal wall closure. Effects of the surgeon’s experience level on the SL:WL ratio were evaluated, hypothesizing that small animal surgeons do not spontaneously apply SL:WL ratios equal to or larger than 4:1.

Procedures

Three groups of surgeons with varying levels of experience performed 4 simple continuous sutures before (3 sutures) and after (1 suture) being educated on principles of the SL:WL ratio. All sutures were evaluated for their gaping, number of stitches, stitch intervals, tissue bite size and suture length.

Results

No significant differences in suture parameters or SL:WL ratios were found among the 3 groups, and 60.5% of control sutures and 77.0% of test sutures had SL:WL ratios above 4:1. There was a significant improvement in the mean ratio after the information was provided (p = 0.003). Overall, the SL:WL ratios ranged from 1.54:1 to 6.81:1, with 36.3% falling between 4:1 and 5:1 (5.17 mm mean stitch interval, 5.52 mm mean tissue bite size). A significant negative correlation was observed between the SL:WL ratio and the stitch interval to tissue bite ratio (r = -0.886). Forty-nine of 120 sutures fulfilled the current recommendations for abdominal wall closure with a mean SL:WL ratio of 4.1:1.

Conclusion

A SL:WL ratio larger than 4:1 was achieved in 60% of the control sutures and in 77% of test sutures. Additional animal studies are necessary to evaluate the SL/WL ratio in small animal surgery.

Evaluation of peer teaching and deliberate practice to teach veterinary surgery

OBJECTIVE

To assess the impact of peer teaching and deliberate practice on surgical skills acquisition and retention in first- and second-year veterinary students.

STUDY DESIGN

Randomized, prospective, comparative study.

SAMPLE POPULATION

Eighteen first-year and 25 second-year students from 1 college of veterinary medicine who had previously demonstrated proficiency in basic surgical skills.

METHODS

Forty-three participants were divided into 3 groups: the test group (group A, n = 15), who participated in a structured peer-assisted learning program using deliberate practice; the time-practice control group (group B, n = 15), who participated in an unstructured peer-supported environment; and the assessment-only control group (group C, n = 13), who participated in the assessments. Participants performed a subcutaneous mass removal on a cadaver model and were assessed via a global rating system. Three assessment points were evaluated: pretraining, immediate posttraining, and retention.

RESULTS

The number of participants who achieved acceptable or excellent grand total scores in group A increased after training. Among all participants, 22% in group A, 35% in group B, and 38% in group C did not achieve an acceptable total score at the retention assessment.

CONCLUSION

The study population improved in skill level and retention through the use of standardized video and peer instruction with attention to effective learning strategies, particularly deliberate practice.

CLINICAL SIGNIFICANCE

Use and enhancement of the format introduced in this study could augment veterinary surgical education.

Outcomes of elective gonadectomy procedures performed on dogs and cats by veterinary students and shelter veterinarians in a shelter environment

OBJECTIVE To determine complication rates for elective gonadectomy procedures performed by veterinary students on dogs and cats in an animal shelter, characterize these complications, and compare rates with those for shelter-employed veterinarians (SEVs). DESIGN Retrospective cohort study. ANIMALS 10,073 dogs and cats for which gonadectomy was performed by a veterinary student (n = 3,048 surgeries) or SEV (7,025 surgeries) at an urban animal shelter over a 16-month period. PROCEDURES Electronic medical records for included dogs and cats were reviewed and data collected regarding patient signalment, duration of gonadectomy, surgeon type (student or SEV), and types of surgical complications recorded (including death or euthanasia) during the period from anesthetic induction to 72 hours after surgery. Complication and mortality rates were compared between veterinary students and SEVs. RESULTS No significant differences were identified between students and SEVs regarding rates of overall complications for both species, minor complications for both species, major complications for both species, and overall complications for dogs or cats specifically. The most common complications were self-limiting, with no long-term consequences, for both students and SEVs. Differences in mortality rates between students and SEVs could not be definitively determined owing to low numbers of nonsurviving patients. CONCLUSIONS AND CLINICAL RELEVANCE With judicious case selection and as a part of a surgical training program, complication rates for veterinary student-performed gonadectomy procedures for dogs and cats were no different from those for SEV-performed gonadectomy procedures. We believe such information regarding patient outcomes will allow shelter staff to make informed decisions and help them in discussions with stakeholders who may have concerns about student participation.

Impact of Team Communication Training on Performance and Self-Assessment of Team Functioning during Sophomore Surgery

Collaboration and teamwork are important skills for veterinary professionals that affect relationship development, health and well-being, financial success, and clinical outcomes. This study explores the impact of team communication training on performance and assessment of team functioning during second-year surgery by comparing two different classes. The class of 2017 (control group) received no formal training in team communication before their participation in surgery, and the class of 2018 (treatment group) participated in training offered through a dedicated team communication course. Results showed that team training increased surgical preparation times and had a positive impact on perceptions of competence in some teamwork behaviors. Both cohorts identified similar challenges and solutions associated with teamwork, although the team-trained students responded to challenges differently than the control group. Team communication training had a positive impact on students' ability to plan and organize their experiences, navigate team dynamics in the moment, and respond to stress in a positive manner. These findings suggest that team training does, in fact, make a difference in students' abilities to navigate a team task productively.

Veterinary Student Confidence after Practicing with a New Surgical Training Model for Feline Ovariohysterectomy

Lack of confidence and self-efficacy are the main causes of negative emotions experienced by veterinary students when performing surgery. A surgical training model (STM) was developed to test the hypothesis that practical training on an STM before performing live surgery would enhance the students' confidence. In addition, low-cost and easily accessible materials were used for the construction. In the STM, neodymium magnets that were detached if too much traction was applied were used to ensure careful tissue handling during ligation of the ovarian pedicles and cervix. A pilot study was performed to evaluate veterinary undergraduate students' confidence when using the STM before performing their first live feline ovariohysterectomy (OHE) as lead surgeon. The results showed that the students rated their confidence level higher after performing feline OHE if they had practiced with the STM before surgery. Voluntary written comments revealed that live surgery as a learning situation could have a very negative emotional impact on some students.

Surgical Skills Training with Cryopreserved Rat Stomachs

The objective of this study is to present a high-fidelity bench model of cryopreserved stomachs that can be used while learning surgical skills. Thirty stomachs were harvested from Wistar rats at the end of non-abdominal research studies. The stomachs were washed with cold saline solution and filled with hyaluronic acid solution. The organs were then placed into cryovials and cryopreserved at -30 °C for 60 days. The stomachs were thawed to room temperature on the day of the surgical skills practice and two full-thickness incisions were made. Reporting on their experiences, 22 participants (73.33%) felt that the cryopreserved stomach was identical to in vivo rat stomachs, 24 (80.00%) reported that the stomach was easy to handle, and 27 (90%) reported the tissue was non-friable. Moreover, 29 participants (96.6%) finished the suturing without tears and 100% recommended it as a biomaterial for surgical training. The cryopreserved stomach is a practical, reproducible, low-cost, and high-fidelity bench model that allows surgical fellows to learn how to handle a stomach and improve their surgical abilities before performing surgery on patients or laboratory animals.

Student Preparation and the Power of Visual Input in Veterinary Surgical Education: An Empirical Study

In recent years, veterinary educational institutions have implemented alternative teaching methods, including video demonstrations of surgical procedures. However, the power of the dynamic visual input from videos in relation to recollection of a surgical procedure has never been evaluated. The aim of this study was to investigate how veterinary surgical students perceived the influence of different educational materials on recollection of a surgical procedure. Furthermore, we investigated if surgical technique was associated with a certain method of recollection or use of educational material. During a basic surgical skills course, 112 fourth-year veterinary students participated in the study by completing a questionnaire regarding method of recollection, influence of individual types of educational input, and homework preparation. Furthermore, we observed students performing an orchiectomy in a terminal pig lab. Preparation for the pig lab consisted of homework (textbook, online material, including videos), lecture, cadaver lab, and toy animal models in a skills lab. In the instructional video, a detail was used that was not described elsewhere. Results show that 60% of the students used a visual dynamic method as their main method of recollection and that video was considered the most influential educational input with respect to recollection of a specific procedure. Observation of students' performance during the orchiectomy showed no clear association with students' method of recollection but a significant association (p=.002) with educational input. Our results illustrate the power of a visual input and support prior findings that knowledge is constructed from multiple sources of information.

Veterinary Students' Recollection Methods for Surgical Procedures: A Qualitative Study

When veterinary students face their first live animal surgeries, their level of anxiety is generally high and this can affect their ability to recall the procedure they are about to undertake. Multimodal teaching methods have previously been shown to enhance learning and facilitate recall; however, student preferences for recollection methods when translating theory into practice have not been documented. The aim of this study was to investigate veterinary students' experience with recollection of a surgical procedure they were about to perform after using multiple methods for preparation. From a group of 171 veterinary students enrolled in a basic surgery course, 26 students were randomly selected to participate in semi-structured interviews. Results showed that 58% of the students used a visual, dynamic method of recollection, mentally visualizing the video they had watched as part of their multimodal preparation. A mental recipe was used by 15%, whereas 12% mentally visualized their own notes. The study provides new information regarding veterinary students' methods of recollection of surgical procedures and indicates that in Danish veterinary students, a visual dynamic method is the most commonly used. This is relevant information in the current educational situation, which uses an array of educational tools, and it stresses the importance of supporting the traditional surgical teaching methods with high-quality instructional videos.

Teaching veterinary anesthesia and surgery: the impact of instructor availability on anesthesia, operative, and recovery times in dogs undergoing ovariohysterectomy or castration

Veterinary students learning to perform elective ovariohysterectomy (OVH) and castration procedures have traditionally been taught by a few instructors supervising many student groups simultaneously. This study, using a historical control group, explored the impacts of having a dedicated instructor with each student group for anesthetic induction and an entire surgical procedure. Our hypothesis was that preparation, surgical, and anesthesia times would be shorter and, consequently, post-operative recovery times would be shorter with a dedicated instructor compared to traditional methods. Anesthesia records of dogs undergoing elective surgery by third-year veterinary students were reviewed over 3 consecutive years. Traditional instruction was used in year 1 (Y1), and a dedicated instructor per student group was used in year 2 (Y2) and year 3 (Y3). Anesthesia time, surgical time, recovery time, and pre- and post-operative rectal temperature were analyzed, and a stepwise regression model was developed for factors influencing recovery time. Of 206 records reviewed (Y1, 33; Y2, 98; Y3, 75), there were 101 OVH procedures and 105 castration procedures. Preparation, surgery, and anesthesia times were longer in animals undergoing surgery in Y1, when the traditional instruction method was used. Recovery time was not influenced by instructor assignment. Using dedicated instructors to teach OVH and castration to third-year veterinary students decreased overall anesthesia time by 36 to 49 minutes for OVH and 29 to 32 minutes for castration. A teaching model of dedicated instructors requires excellent coordination between surgeons and anesthesiologists to ensure that a similar number of animals can undergo procedures in the time allotted for teaching.

Service learning: Priority 4 Paws mobile surgical service for shelter animals

The increasing attention given to competencies needed to enter the workforce has revealed a need for veterinary students to gain more experience in performing small-animal elective surgery before graduation. In addition, guidelines for standards of care for shelter animals recommend that all dogs and cats should be spayed or neutered before adoption. Teaching surgical skills while serving the needs of local animal shelters represents an ideal service-learning opportunity. Following a pilot study and the benchmarking of other programs, an elective course in shelter medicine and surgery was created at Purdue University College of Veterinary Medicine (PVM) to allow senior DVM students an opportunity to spend 2 weeks on a mobile surgery unit (Priority 4 Paws) and 1 week at an animal shelter. With financial assistance from sponsors and donors, PVM purchased and equipped a mobile surgery unit, hired a full-time veterinarian and a registered veterinary technician, and established relationships with 12 animal shelters. From July 30, 2012, to March 22, 2013, 1,941 spays and neuters were performed with excellent postsurgical outcomes while training 33 veterinary students on rotation and 26 veterinary technician students. The program was well accepted by both students and the shelters being served. The Priority 4 Paws program is an example of an integrated, community-based service-learning opportunity that not only helps to improve the surgical skills of veterinary students but also helps to meet an identified community need.

Developments in undergraduate teaching of small-animal soft-tissue surgical skills at the University of Sydney

This article discusses recent developments in soft-tissue surgery teaching at the University of Sydney, Faculty of Veterinary Science. An integrated teaching program was developed for Bachelor of Veterinary Science (BVSc) students with the aim of providing them with optimal learning opportunities to meet "Day One" small-animal soft-tissue surgical competencies. Didactic lectures and tutorials were introduced earlier into the curriculum to prepare students for live-animal surgery practical. In addition to existing clinics, additional spay/neuter clinics were established in collaboration with animal welfare organizations to increase student exposure to live-animal surgery. A silicon-based, life-like canine ovariohysterectomy model was developed with the assistance of a model-making and special effects company. The model features elastic ovarian pedicles and suspensory ligaments, which can be stretched and broken like those of an actual dog. To monitor the volume and type of student surgical experience, an E-portfolio resource was established. This resource allows for the tracking of numbers of live, student-performed desexing surgeries and incorporates competency-based assessments and reflective tasks to be completed by students. Student feedback on the integrated surgical soft-tissue teaching program was assessed. Respondents were assessed in the fourth year of the degree and will have further opportunities to develop Day One small-animal soft-tissue surgical competencies in the fifth year. Ninety-four percent of respondents agreed or strongly agreed that they were motivated to participate in all aspects of the program, while 78% agreed or strongly agreed that they received an adequate opportunity to develop their skills and confidence in ovariohysterectomy or castration procedures through the fourth-year curriculum.

Translating human simulation technologies to veterinary surgical training: accelerating adoption

Through the reduction of live animal use in teaching surgical technique, the opportunities to deliberately study complex regional anatomy and practice surgical technique have decreased. With reduced exposure, there is concern some individuals are graduating without the requisite knowledge and proficiency to perform adequate surgical techniques. Ultimately, animals may unnecessarily suffer due to morbidities from limited or poor surgical competencies. We have translated developments derived from the human surgical simulation field for application to veterinary surgical training. We present our work on intuitive software for learning regional anatomy, surgical simulations, and on several limiting factors that impede the validation and adoption of simulation technologies for use by the veterinarian surgical community.

Vertically integrated educational collaboration between a college of veterinary medicine and a non-profit animal shelter

The College of Veterinary Medicine and Biomedical Sciences (CVMBS) at Texas A&M University (TAMU) has developed a multifaceted program in partnership with the Brazos Animal Shelter to provide teaching opportunities with shelter animals during all four years of the professional curriculum. In the first three semesters of the professional program, students working in small groups spend two hours per semester at the shelter performing physical examinations, administering vaccinations and anthelmintics, completing heartworm or FeLV/FIV testing, and performing simple medical treatments. In an expanded fourth-year program, groups of six students spend 16 contact hours at the shelter during two-week rotations, completing similar tasks. Through this program, each student practices animal-handling skills and routine procedures on an average of 150 to 200 dogs and cats. In addition, during third- and fourth-year surgery courses, student teams spay or neuter an average of 12 to 18 dogs or cats each week. More than 800 animals are spayed/neutered annually through this program, and each student directly participates in 12 to 15 spay/neuter survival surgeries. The program represents a creative approach to veterinary training that conscientiously uses animal resources in a positive fashion. We believe that this is a successful partnership between a state-supported veterinary college and a non-profit shelter that benefits both agencies. We encourage other veterinary colleges to explore similar partnership opportunities to provide optimal training for professional students while using animal resources efficiently.

Teaching veterinary students using shelter animals

Veterinary teaching hospitals (VTHs) are experiencing case-load trends that have negatively affected efforts to prepare students for entry-level veterinary practice, particularly in the area of technical skills training. This article examines the clinical training available to veterinary students through a variety of collaborative shelter models. Benefits and potential problems related to initiating a collaborative shelter clinical training program are reviewed. Collaborative efforts between animal shelters and veterinary schools can provide crucial opportunities for outreach teaching initiatives, particularly for teaching medical and surgical skills.

The effectiveness of humane teaching methods in veterinary education

Animal use resulting in harm or death has historically played an integral role in veterinary education, in disciplines such as surgery, physiology, biochemistry, anatomy, pharmacology, and parasitology. However, many non-harmful alternatives now exist, including computer simulations, high quality videos, ''ethically-sourced cadavers'' such as from animals euthanased for medical reasons, preserved specimens, models and surgical simulators, non-invasive self-experimentation, and supervised clinical experiences. Veterinary students seeking to use such methods often face strong opposition from faculty members, who usually cite concerns about their teaching efficacy. Consequently, studies of veterinary students were reviewed comparing learning outcomes generated by non-harmful teaching methods with those achieved by harmful animal use. Of eleven published from 1989 to 2006, nine assessed surgical training--historically the discipline involving greatest harmful animal use. 45.5% (5/11) demonstrated superior learning outcomes using more humane alternatives. Another 45.5% (5/11) demonstrated equivalent learning outcomes, and 9.1% (1/11) demonstrated inferior learning outcomes. Twenty one studies of non-veterinary students in related academic disciplines were also published from 1968 to 2004. 38.1% (8/21) demonstrated superior, 52.4% (11/21) demonstrated equivalent, and 9.5% (2/21) demonstrated inferior learning outcomes using humane alternatives. Twenty nine papers in which comparison with harmful animal use did not occur illustrated additional benefits of humane teaching methods in veterinary education, including: time and cost savings, enhanced potential for customisation and repeatability of the learning exercise, increased student confidence and satisfaction, increased compliance with animal use legislation, elimination of objections to the use of purpose-killed animals, and integration of clinical perspectives and ethics early in the curriculum. The evidence demonstrates that veterinary educators can best serve their students and animals, while minimising financial and time burdens, by introducing well-designed teaching methods not reliant on harmful animal use.

Outcomes of adoption of adult laboratory ferrets after gonadectomy during a veterinary student teaching exercise

We surveyed 27 people who had adopted a total of 43 adult domestic ferrets after their use in a series of veterinary student surgery teaching laboratories to assess the success of those adoptions and to determine the rate of occurrence of common maladies of domestic ferrets after adult gonadectomy as compared with the usual practice of early-age gonadectomy. The adoptions took place 1-7 y prior to the survey. The response rate was 48% of adopters, covering 53% of the ferrets. Overall the success of former breeding and instructional ferrets as pets were rated as 91% good or excellent and 4.5% poor. Behavioral issues (for example, nipping, failure to litter train) were noted as the most common problems (36% of ferrets). Adrenal gland disease, insulinoma, or lymphosarcoma occurred in 23% of all ferrets and accounted for 57% of those ferrets that had died prior to the time of the survey.

New Alternative Methods to Teach Surgical Techniques for Veterinary Medicine Students despite the Absence of Living Animals. Is that an Academic Paradox?

Due to a raised ethical mentality, veterinary schools are pursuing methods to preserve animal corpses used for surgical technique classes in an attempt to reduce the use of living animals for teaching. Generally speaking, animal and human bodies are usually preserved with 10% aqueous formalin solution especially for descriptive anatomy classes. Other possibilities include the use of glycerol, alcohol and phenol. At present, new fixatives have been developed to allow a better and longer preservation of animal corpses in order to maintain organoleptic characteristics, i.e. colour, texture, as close as possible to what students will deal with living animals. From 2004, in our college, surgical technique classes no longer use living animals for students' training. Instead, canine corpses chemically preserved with modified Larssen (MLS) and Laskowski (LS) solutions are preferred. The purpose of this study was to investigate comparatively the biological quality of preservation of these two solutions and to evaluate students' learning and acceptance of this new teaching method. Although these fixatives maintain body flexibility, LS solution failed to keep an ordinary tissue colouration (cadavers were intensely red) and tissue preservation was not adequate. By contrast, MLS solution, however, did not alter the colouration of cadavers which was fairly similar to that normally found in living animals. A remarkable characteristic was a very strong and unpleasant sugary odour in LS-preserved animals and therefore the MLS solution was the elected method to preserve cadavers for surgical technique classes. The students' feedback to the use of Larssen-preserved cadavers was very satisfactory, i.e. 96.6% of students were in favour of the use of cadavers for surgical training and on average 91.8% (2002-2003) of students preferred the MLS solution as the chemical preserver, whereas only 8.2% elected LS solution for teaching purposes. From the students' point of view (95.1%) the ideal class would be an initial training in MLS cadavers followed by classes with animals admitted to the Veterinary Hospital.

Teaching surgery to the veterinary novice: the Ohio State University experience

Surgical training in veterinary medicine has evolved rapidly over the past several decades. Catalysts for change include pressure from concerned students and the public to reduce the use of live animals in teaching; less-than-effective preparation of students for live surgery experience; an overall reduction in faculty time and effort devoted to skills training; college budgetary reallocations mandating reductions in expensive group laboratory experiences; and more specialized case-load patterns in clinical rotations, which have reduced students' exposure to common surgical conditions. In response to these trends, methods for surgery educators to reduce, refine, and replace live animals in surgery training courses at veterinary schools have received broad attention. When these methods are used effectively in a curriculum, it is no longer necessary to sacrifice animals for adequate student training. This article describes a successful and ethical surgical training program used at the Ohio State University College of Veterinary Medicine (OSU-CVM). This program provides early exposure to skills training using surgical simulators and auto-tutorials, ensures that basic skills are mastered before students are exposed to cadaver practice, and requires application of model-based skills to cadavers, with final matriculation to intensive exposure to multiple live-animal procedures via a collaborative surgery program with a local shelter.

Taking things apart: ovario-hysterectomy--textbook knowledge and actual practice in veterinary surgery

Veterinary surgery provides an interesting context in which to address important questions about the links between formal 'book' learning and actual, personal experience of the phenomena in question, and to examine the processes through which these links are forged. Participant observation of surgical procedures suggests that surgeons initially learn about anatomy from books, pictures and demonstrations, and become skilled 'operators' through the application of enhancement and reduction procedures that have the effect of transforming the living body into something more closely resembling anatomical pictures of it. Some of these procedures can be seen as a set of formalized 'rules' for performing operations, and like most rules, they appear to decrease in importance as a surgeon gains experience. They may, however, regain importance when a practitioner meets with an anatomical variant that he or she has not previously encountered. Other practices appear to be less formalized, requiring creative, constructive use of visual aids or language practices outside formal textbook knowledge. The links between actual bodies (and operations) and textbook representations of them are thus formed within a community of 'operators'.

Retention of surgery specialists in academia: a critical agenda

Recruitment and retention of specialists to academia appears to be a growing problem in university teaching hospitals. Members of the American College of Veterinary Surgeons (ACVS) believe that the movement of surgery specialists to practice may have an impact on the training of veterinary students and surgery residents. To address these concerns, 1,071 ACVS diplomates and 60 department heads and hospital directors from all veterinary schools in North America were surveyed to determine whether a problem exists, the extent of the problem, and potential reasons for migration of specialists to practice. Responses were obtained from 620 ACVS diplomates (58 per cent) and 38 department heads and hospital directors (63%) from 28 different universities. The responses confirmed a net movement of surgery specialists from academia to practice. Eighty seven percent of department heads and hospital directors believed there was a shortage of small animal surgery specialists in academia; this information was supported by the fact that 47% responded that they had open positions and 68% had difficulty filling positions in the last five years. The demand was slightly less for large animal surgery specialists, and 42 per cent of respondents indicated that they had open positions. Financial considerations were the most common reason for surgery specialists to move from academia to private practice. Seventy-six percent of responding ACVS diplomates in private practice had a total compensation package valued at greater than $125,000 per year, whereas 77.8% of diplomates in academia had total compensation valued at $125,000 or less. Most universities offer starting salaries (not including benefits) for recently certified surgery specialists ranging from $70,000 to $90,000. Reasons for moving from academia to practice besides financial considerations included undesirable location of university hospitals; lack of interest in research; and a belief that university administration was not supportive of surgery specialists. Many academic surgery specialists were frustrated by the requirement for productivity in research, teaching, and service for promotion in tenure-track positions.

Preservation of Cadavers for Surgical Technique Training

OBJECTIVE

To evaluate a technique for preservation of organoleptic tissue characteristics (color, odor, texture, and flexibility) in cadavers used for surgical instruction.

STUDY DESIGN

Experimental study.

ANIMALS

Forty-three canine cadavers.

METHODS

Cadavers were preserved with a modified Larssen solution of the Hospital Cochim, Paris and cryopreservation. Tissue handling qualities were evaluated in surgical laboratory sessions.

RESULTS

All cadavers kept texture and tissues consistency, especially skin and muscle, similar to those of live animals. Some skin desquamation and pallor of the mucous membranes occurred with repetitive freeze-thaw cycles.

CONCLUSIONS

This preservation technique provides acceptable cadaver quality and tissue handling for use in surgical instruction.

CLINICAL RELEVANCE

Preparation of patient cadavers by intravascular injection of modified Larssen solution yielded suitable instructional models for surgical training.

Applying the "3 Rs": training course in surgical techniques

As the use of surgical procedures in rodents becomes increasingly common in biomedical research, institutions face the challenge of ensuring that personnel are properly trained to perform these procedures. The author describes a microsurgery training course in use at Columbia University.

Determinants of adoption and euthanasia of shelter dogs spayed or neutered in the university of california veterinary student surgery program compared to other shelter dogs

Limited economic resources and pet overpopulation force animals shelters to consider euthanasia of adoptable animals every day. Veterinary medical schools can play a positive role in increasing pet adoption and combating overpopulation by providing free neutering for shelter animals. This retrospective cohort study illustrated that the cooperative efforts of a veterinary medicine surgical teaching program and local animal shelters decreases euthanasia of adoptable pets. At the University of California, Davis (UCD), shelter dogs are neutered by veterinary students and then returned to the shelter for adoption. The rates of adoption and euthanasia of the dogs neutered at UCD were contrasted with a comparison shelter group to determine the effect of pre-adoption neutering. The UCD-neutered dogs had a lower rate of euthanasia than the comparison shelter group at the shelters investigated. At Sacramento County Animal Care and Regulation, 73% of the UCD group but only 36% of the comparison group were adopted. At Yolo County Animal Services, 71% of the UCD group and 45% of the comparison group were adopted. The sex of an animal did not significantly affect the rate of euthanasia. Dogs that were predominantly pit bull, rottweiler, or chow chow breeds had higher rates of euthanasia than other breeds, independent of neuter status. Also, juveniles (less than one year old) had lower rates of euthanasia than adults, independent of neuter status. UCD adult dogs had lower rates of euthanasia than comparison adults. Post-surgical UCD dogs spent a longer average time in the shelter before adoption (15 days at Sacramento; 16 days at Yolo) than the comparison dogs (11 and 12 days, respectively). UCD dogs also spent a longer average time in the shelter before euthanasia (18 and 25 days, respectively) than the comparison dogs (13 days at both shelters). Lower probabilities of euthanasia for behavioral or medical reasons were found for UCD dogs than for the comparison dogs. The probability of euthanasia for reasons of space limitations increased with time in shelter for both groups. In this study, pre-adoption neutering increased adoptions without increasing the probability of medical or behavioral euthanasia.

One educator's perspective on the role of instructional technology in veterinary surgical education

A brief overview of the history of instructional technology (IT) use in veterinary surgery education is followed by an assessment of the state of the art in this discipline in the United States. Comments on assessment of teaching tools and the need for a concerted effort at future assessments are made in light of published information regarding the success of alternative learning methods in education in other disciplines. A few final comments are shared about discipline specific technology demands in surgical education and the issue of copyrights versus sharing resources.

Support needs of veterinary surgeons during the first few years of practice: perceptions of recent graduates and senior partners

Postal surveys or personal interviews of 76 recent veterinary graduates and their 49 employers were undertaken to establish their perceptions of good practice when integrating a new graduate into a business and their preferred methods of assessment and development. Practice type and location were the main influences on graduates looking for their first job. Interviews were mostly informal. Employers expected basic veterinary competence and candidates expected good quality support. Most graduates (93 per cent) had their own consultations on the first day. During early consultations 2 per cent of senior vets accompanied the new graduate, 95 per cent of practices provided senior back-up either in person or by telephone but in 3 per cent no back-up was available. Most new graduates (90 per cent) were satisfied with their workload. Three-fifths were on-call within the first week, and 95 per cent within a month. Graduates received calls directly in 45 per cent of practices, in 9 per cent seniors screened the calls, and the remainder used a third party. Assistance from experienced lay staff varied greatly. Discussion of problems was mainly informal. There was little spontaneous feedback and problems resulted from inadequate communication. One in three new graduates left their first job within two years, and one in six identified lack of support, heavy workload, stress or clashes with staff as a primary reason. This high turnover was a problem for employers. From the new graduates' perspectives, initial problems included: being on call (59 per cent), financial aspects (47 per cent) and surgery (43 per cent). Communicating with clients and learning to prioritise jobs were also difficult. New graduates took longer over procedures (79 per cent of employers commented) and required extra back-up (91 per cent) both of which reduced income (59 per cent). Nearly all the seniors felt that their current new graduates had coped 'quite well', although it was claimed that new graduates lacked the ability to talk to clients at the appropriate level, wanted to bring all their scientific knowledge to bear on every case, and often failed to consider the obvious or to appreciate clients' needs. Only 18 per cent of practices had formal and regular review procedures but all monitored the response of clients and watched the new graduate perform. Feedback to their new colleague was considered 'adequate' by 85 per cent of seniors, although 45 per cent of graduates felt they had not received enough. Eighty-three per cent of new graduates felt 'moderately prepared' by their undergraduate course, and 76 per cent of senior vets were 'generally satisfied' Both wanted improvements in extramural studies and increased exposure to routine cases. Senior partners sought greater commitment in the undergraduate curriculum to financial/legal issues and communication skills. Over a third of employers (38 per cent) had a 'great influence' on the choice of continuing professional development courses for their recent graduates. New graduates chose courses to deal with a perceived weakness, or to specialise, and welcomed opportunities to meet other new graduates and share early experiences. It was concluded that turnover and staff problems would be reduced if practices became more effective in coping with new arrivals, especially by supporting their development.

Surgical education: attitudes toward animal use in teaching surgery at Louisiana State University

Concerns over the use of animals in teaching have lead to a reduction in the number of live animal laboratories. A survey of 275 students and faculty was conducted to characterize their attitude toward the use of animals in teaching surgery. Respondents favored live animal use. They believed that model laboratories were helpful in learning aseptic technique and suturing skills but less helpful in learning tissue handling, dissection, hemostasis, or anesthesia.

Evaluation of a hemostasis model for teaching ovariohysterectomy in veterinary surgery

OBJECTIVE

To evaluate the efficacy of a reusable plastic model mimicking the anatomy and hemodynamics of the canine female genital tract for teaching basic surgical skills and ovariohysterectomy.

SAMPLE POPULATION

40 veterinary students of the class of 1998.

STUDY DESIGN

Prospective study.

METHODS

Students'confidence level and experience in private practice was evaluated via questionnaire before training. Students in 2 groups performed an ovariohysterectomy on cadavers (group C, n = 20) or on the model (Group M, n = 20) for 2 hours. Students' psychomotor and basic surgical skills were objectively assessed by the following tests: ligation of a foam cylinder, passing a needle through the eyelets of an electronic suture board, and ligating latex tubing. Results were compared before and after training and within and between groups. The ability of students to perform an ovariohysterectomy in a live dog after training was compared between groups with a scoring system.

RESULTS

Students in both groups had similar surgical experience and basic skills before training. The results of the psychomotor and basic surgical skills tests were better in group M after training than group C. The improvement of each student in performing these tasks also increased when students were trained with the model. Scores assigned to students performing an ovariohysterectomy in a live dog were higher in group M (31.45 +/- 1.15) than in group C (20.7 +/- 1.42).

CONCLUSION

The model was more effective than cadavers in teaching basic surgical skills and ovariohysterectomy in dogs.