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A Non-Animal Alternative For Teaching Introductory Surgery

DAVID L. HOLMBERG      JOANNE R. COCKSHUTT

The authors describe a non-animal surrogate for teaching the basic principles of abdominal surgery which was developed at the Ontario Veterinary College. This model has been well received by students and is considered by them and their instructors to be an effective, low stress (for animals and humans) method of preparing for live animal surgery. Its use has reduced the need for animals in teaching abdominal surgery at several institutions and follows the trend of today's society in its demands for non-living teaching models. The authors suggest the use of an abdominal surrogate as an aesthetically acceptable alternative to live animal or cadaver surgery for some introductory surgical laboratories.
KEY WORD INDEX:
surgery, veterinary, animal welfare,
humane, education
About the Author

Most veterinary institutions use animals, either alive or as cadavers, for teaching surgical techniques. The integration of students into clinical surgery on client-owned animals who have been presented to a teaching hospital may be the ideal method of instruction but requires considerably more student contact time and larger faculty numbers than are available at most schools (Jennings, 1986). The advanced type of referral case which is seen at university hospitals is also generally considered to be inappropriate for training the novice surgeon. Cadavers are often used to replace live animal surgery and the success of this alternative has been reported (Bauer, 1992). However, unless a reliable supply of fresh cadavers is available, these bodies usually have to be stored for varying periods of time prior to their use. This requires freezer space and thawed tissues are quite abnormal and aesthetically unpleasant.

Non-animal alternatives are available for developing the student's psychomotor skills and teaching ligation of blood vessels (Bauer, 1992). There are also artificial skin models available for practicing suturing, and plastic bones for teaching orthopedics (Johnson, 1990; DeYoung, 1987). There has not been a non-animal model in general use for teaching the principles of abdominal surgery. We therefore developed our own dog abdominal surrogate for instructional exercises (DASIE). Each DASIE consists of a cylinder of laminated foam rubber and fabric with rectangular reinforcement blocks in the ends (Figure A). The multiple layers of the outer shell are designed to be cut, handled and sutured individually, much like the tissues of the canine abdomen. Colored threads are incorporated between the layers of the DASIE wall to simulate blood vessels that are transacted by a skin and subcutaneous incision. These mock vessels can be grasped with hemostats and ligated. Within the cavity of the DASIE is a length of polyurethane foam tube that can be cut and sutured using the same instruments and suture patterns as would be used clinically for abdominal, gastrointestinal, and urogenital procedures.

The DASIE was integrated into the undergraduate surgery training programs at the Ontario and Atlantic Veterinary Colleges to teach abdominal draping, aseptic technique, the use of surgical instruments and the rudiments of tissue handling. During the laboratory session, students incised through the wall of the DASIE, performed an end-to-end anastomosis on the artificial intestine, and sutured the wall incision in three layers using standard aseptic technique (Figures B, C, D, E). Following completion of the DASIE laboratory, a questionnaire was used to evaluate student acceptance of this teaching model. Results of this study have been published (Holmberg, Cockshutt, Basher, 1993).

Faculty and staff involved in monitoring the laboratories reported that students took the DASIE training seriously and gained useful practice and confidence from performing the exercise. Practicing their surgical skills on an inanimate model, rather than a live animal, helped reduce student apprehension by minimizing the consequences of faulty technique. A total of 116 students completed the questionnaire. Ninety-six percent of these students agreed with the use of live animals for teaching surgery provided that the animals were treated humanely.

Since the completion of this study, the majority of our students have purchased their own DASIEs to practice surgical techniques outside the formal laboratory session; this may be the most suitable use for the DASIE. Repetition of procedures facilitates improvement in motor skills and, for this, models may be superior to live animals (Johnson & Farmer, 1989; Smeak, Beck, Shaffer, & Gregg, 1991). The purchase price of a DASIE is approximately one tenth that of a purpose bred dog at our facilities. Because of its cylindrical shape, each surrogate can be rotated to allow six to eight incisions without affecting its teaching relevance. This multiple use capability increases the potential cost savings to institutions and value of the model for the students.

AVAILABILITY:

Since we have made the DASIE available to other facilities, five veterinary colleges, several research institutions, and three technical schools have made the DASIE part of their teaching programs. The cost of a DASIE is $15.00 (US). A 37-minute video which demonstrates the use of the DASIE (draping, suture patterns, etc.) is also available for $50.00 (US) and is intended for pre-laboratory viewing by the student and instructor. All profits from the sale of the DASIE are placed into a departmental trust fund dedicated to the development of non-animal models for teaching clinical surgery. Inquiries should be directed to Dr. D. L. Holmberg, Dept. of Clinical Studies, Ontario Veterinary College, Guelph, Ontario, Canada, N1G 2W1.

ACKNOWLEDGEMENT:

Partial funding for this project was granted by the University of Guelph's Center for Animal Welfare and the Pet Trust Fund.


REFERENCES:

Bauer, M.S., Glickman. N., Glickman. L., Toombs. J.P., & Bill. P. (1992). Evaluation of the effectiveness of a cadaver laboratory during a 4th-year veterinary surgery rotation. Journal of Veterinary Medical Education, 19, 77-84.
Bauer, M.S. & Seim. H.B. (1992). Alternative Methods to Teach Veterinary Surgery. Humane Innovations and Alternatives, 6, 401-404.
DeYoung, D.J. & Richardson, D.C. (1987). Teaching the principles of internal fixation of fractures with plastic bone models. Journal of Veterinary Medical Education, 14, 30-31.
Holmberg, D.L., Cockshutt. J.R., & Basher, A.W.P. (1993). Use of a dog abdominal surrogate for teaching surgery. Journal of Veterinary Medical Education, 20, 107-111.
Jennings, P.B. (1986). Alternative to the use of living animals in the student surgery laboratory. Journal of Veterinary Medical Education, 13, 14-16.
Johnson, A.L. & Farmer, J.A. (1989). Evaluation of traditional and alternative models in psychomotor laboratories for veterinary surgery. Journal of Veterinary Medical Education, 16, 11-14.
Johnson, A.L., Harari, J., Lincoln, J., Farmer, J.A., & Korvick, D. (1990). Bone models of pathological conditions used for teaching veterinary orthopedic surgery. Journal of Veterinary Medical Education, 17, 13-15.
Smeak, D.D., Beck, M.L., Shaffer, C.A., & Gregg, C.G. (1991). Evaluation of video tape and a simulator for instruction of basic surgical skills. Veterinary Surgery, 20, 30-36.

David L. Holmberg

D.V.M.
Department of Clinical Studies
Ontario Veterinary College
Guelph, Ontario

  David Holmberg received his Doctor of Veterinary Medicine from the University of Minnesota in 1973 and spent several years in private veterinary practice before returning to academia to complete a Masters of Veterinary Science at the University of Saskatchewan. He is a Diplomate in the American College of Veterinary Surgeons and Professor of Small Animal Surgery at the Ontario Veterinary College. Most of his life is devoted to teaching surgery. His household is directed by his 16-year-old three-legged cat, Fuzz Butt, who was adopted after David re-constructed the damage caused by his confrontation with a high tension wire.

Joanne R. Cockshutt

D.V.M.
Department of Clinical Studies
Ontario Veterinary College
Guelph, Ontario

  Joanne Cockshutt received her Doctor of Veterinary Medicine from the University of Saskatchewan and Masters degree from the University of Guelph. She is a Diplomate in the American College of Veterinary Surgeons and a small animal general surgeon at the Ontario Veterinary College. Her current research centers on improving student training in veterinary surgery. She lives with a springer spaniel, Flash, who was adopted after correcting his heart defect.

PSYETA LogoCopies of this journal are no longer available for sale, but our other two journals, Society & Animals and the Journal of Applied Animal Welfare Science, are available and subscriptions are quite affordable. They can be ordered online via our secure order page.

www.PSYETA.org
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