Experience and confidence of final year veterinary students in performing desexing surgeries

A Global Survey of the Views of Practicing Companion Animal Veterinarians on Their Undergraduate Curriculum and Their Access to Continuing Education Resources

A global survey was developed to gain insight into the opinion of companion animal veterinarians about their undergraduate education and their access to continuing education on the following topics: client communication, animal welfare, surgical techniques, human-animal bond, dentistry, animal behavior, and zoonotic disease/epidemiology. In 2016, the survey was distributed via SurveyMonkey® in five languages to companion animal veterinarians around the world. A total of 1,167 respondents returned to the survey. The distribution of survey responses differed by geographic region (number of respondents in parentheses; where respondents work/have been trained): Europa (including the Russian Federation, 359/423), Asia (311/205), North America (77/89), South America (24/16), Africa (46/41), and Oceania (147/167). The results were strongly influenced by a large number of respondents (in parentheses) who graduated in the Russian Federation (180/162), Australia (133/154), Israel (136/82), the Netherlands (64/64), the United Kingdom of Great Britain and Northern Ireland (36/46), and the United States of America (46/44). On the basis of the responses, all topics were poorly covered or not taught, except for surgical techniques and zoonotic disease/epidemiology, which were covered adequately or well. However, there were country and geographic regional differences. This was also true for continuing education resources, which were-in addition to countries and geographic regions-also influenced by the educational topic. As already stated by Dhein and Menon in 2003, time away from the practice, travel distance, and expense may be reasons why companion animal veterinarians do not follow continuing education. Online continuing education could fill in the gap and is more time and cost-efficient.

Confidence among Veterinary Students to Perform Canine Orchiectomy: The Impact of Live Animal Surgical Clinical Training

Canine orchiectomy (COE) is one of the most commonly performed procedures in small animal veterinary surgery. The aim of this study was to assess veterinary students' confidence in performing this surgery in relation to their previous surgical experience of the procedure. The hypothesis was that confidence to perform canine orchiectomies among recent veterinary graduates increased when having participated in the procedure as part of practical surgical training. A cross-sectional survey was conducted and included 65 fifth-year veterinary graduate students at the Swedish University of Agriculture in Uppsala, Sweden. The survey investigated how differences in experience of COE affected students' confidence to perform the procedure. Of the responding students, 24.6% had performed the procedure, 47.7% had observed the procedure live, and 27.7% had not seen nor performed the procedure. They were asked how confident they were to perform the procedure both with and without assistance. Data were compared using a non-parametric test (Mann-Whitney U test). The results showed a statistically significant increase in confidence to perform COEs in the group that had previously performed or observed COE compared with the group that had neither performed nor observed the procedure. In conclusion, veterinary students' participation in COEs significantly contributed to their clinical confidence to perform the procedure.

What's the evidence? A review of current instruction and assessment in veterinary surgical education

Veterinary surgical education is improved by studying the relevant literature. The aim of this literature review was to report the theory and methods used to provide surgical education to veterinary students; to discuss the training most likely to create a competent general practitioner; and to review assessment methods for simulated and live surgeries. The literature reviewed demonstrates that new graduates are expected to perform small animal sterilization, dental extraction, onychectomy, abscess treatment, aural hematoma repair, and mass removal with little or no supervision. Students require repetitive practice to reach competence; some practice can take place in a clinical skills laboratory on models or cadavers. When training novices, distributing practice over a longer time improves retention, but months without practice causes skills to decay. Suturing skills may be taught on models at a ratio of 1 instructor per 10 students. Veterinary students require 6-10 repetitions of each small animal sterilization surgery to reach competence; however, learning curves for other surgeries have not been established. Assessment of surgical skills has been undertaken using objective structured clinical examinations (OSCEs) and observed model and live surgeries. Additional validated rubrics are needed in the field. Surgical educators are urged to continue to search for innovative ways to foster deliberate practice, assess skill, and provide feedback for students.

Ability of a Complexity Scoring System to Predict Veterinary Student Surgical Procedure and Clinic Duration

The Midwestern University College of Veterinary Medicine hosts student-run free clinics that offer surgical sterilization of male and female dogs and cats, with the goal of 20 surgical cases per clinic. Surgical complexity varies significantly between the surgical procedures for males (castration) and females (ovariohysterectomy) and is also influenced by weight and age for dogs. A surgical complexity scoring system was implemented to ensure the minimum number of patients while providing a diverse mix of cases. The aim of this study was to determine whether the surgical complexity scoring system accurately predicted procedure duration. Surgical records were collected between August 2016 and October 2019. Points (1-5) were assigned to each patient at the time of appointment based on species, sex, additional procedure, age and weight, and the schedule was targeted for 50 points. Each point was predicted to account for 15 minutes of surgical time. The duration for each point category was assessed via rank-sum against the predicted median. Sixteen clinics occurred during the study period, having a mean of 40.4 points and 17 patients, 29.5 (74%) of which were allocated to students. There were 264 surgeries, with 241 (91%) having complete start and end times. Surgical duration for student surgeries was not different from the estimate for each point category, with the exception of 2-points, which had a median 5.0 minutes longer than anticipated (p = .0004). The surgical complexity scoring system is an effective tool to optimize scheduling of educational spay/neuter mobile clinics.

Veterinary Clinical Ethics and Patient Care Dilemmas

Veterinary ethical dilemmas are common, complex, and unavoidable. Creating a transparent and deliberate approach to ethical issues empowers the entire veterinary team and reduces stress associated with these dilemmas. This article discusses ethical considerations and principles and propose use of the 4Es model and core communication skills to address ethical dilemmas in veterinary practice. It reviews literature defining ethical issues in practice and provides case examples to show the application of our proposed methods. The goal is to provide veterinary professionals with an approach they can use to frame and address their own ethical decisions.

Smartphone Thermal Imaging in the Detection of Testicular Ischemia

OBJECTIVE

To evaluate smartphone thermal imaging as a point of care test in the detection of testicular ischemia. Thermal imaging detects the infrared (heat) pattern of an object and the technology is now available as an inexpensive attachment to smartphones.

MATERIALS AND METHODS

Smartphone thermal imaging was studied as a point-of-care diagnostic test for testicular ischemia in an IACUC approved study that prioritized survival of all animal subjects. Thirty canines weighing over 12 kg were observed during elective neuter procedures with consent from owners. Randomization determined ligation of the right vs left spermatic cord. With both testicles remaining in the scrotum, blinded inspection was performed with a FLIR ONE Pro thermal imaging camera for smartphone use. The bilateral orchiectomy procedures were then completed as planned.

RESULTS

Within 11 minutes of ligation of the randomized spermatic cord, an obvious change in the thermal imaging pattern allowed for the correct diagnosis of the ischemic testicle in 30/30 (100%) of subjects in a blinded fashion. Temperature differences between testicles at the time of ischemia diagnosis ranged from 0.7°C to 3.7°C with an average difference of 1.79°C lower in the ischemic testicle (95% CI: [1.50, 2.08]). A thermal imaging evaluation of the testicles takes 30 seconds to perform.

CONCLUSION

Smartphone thermal imaging correctly diagnosed testicular ischemia in 100% of animal subjects in a blinded fashion. The clinical utility of this emerging point-of-care technique in the evaluation of testicular torsion is currently unknown.

Experience of Practicing Veterinarians with Supervising Final-Year Students and New Graduates in Performing Desexing Surgeries

With increasing pressure on university teaching hospital caseloads, veterinary students are increasingly being taught basic desexing skills during their final-year extramural rotations or as new graduates in practice. A cross-sectional survey of New Zealand veterinarians was conducted to elicit information about their experiences supervising these cohorts. Of the 162 respondents who had supervised at least one final-year veterinary student, only 95 (58.6%) allowed students to perform desexing surgeries and the most common procedures they allowed students to perform were cat neuters (96%) followed by cat spays (64%), dog neuters (63%), and dog spays (24%). The time needed to supervise students, the liability of students operating on client-owned animals, and students' poor basic instrument, tissue, and suture handling skills were cited as major deterrents. Breaks in sterility and dropped pedicles were the most frequently reported complications, although these still occurred only occasionally or rarely. Of the 101 respondents who had supervised at least one new graduate, all but one provided surgical mentoring. It took an average of 3.3 dog neuters, 8 dog spays, 2.4 cat neuters, and 4.7 cat spays before respondents were comfortable letting new graduates perform surgery unassisted. Respondents generally expected new graduates to perform dog spays in under 60 minutes, cats spays and dog neuters in under 30 minutes, and cat neuters in under 10 minutes. Although most respondents agreed that students needed more hands-on experience with live animal surgery, the main clinical skills deficiencies identified were ones that could easily be trained and practiced on simulated models.

Self-reports of Dutch dog owners on received professional advice, their opinions on castration and behavioural reasons for castrating male dogs

Male dogs are often castrated based on the thought that it facilitates well-behavedness. However, the causal evidence for this from prospective studies lacks and the existing associative studies present mixed results depending on the studied behaviours. We aimed to gain insight into possible factors driving an owner’s decision to castrate their male dog, through a quantitative survey based on a convenience sample. We determined the advice owners received from three types of dog professionals (veterinarian practitioners, behavioural trainers, behavioural therapists) and the owners’ assessments of castration’s behavioural effects. Data on 491 Dutch owners of castrated and intact male dogs were analysed with Chi-square tests. Results indicate that owners of both castrated and intact dogs received castration advice most often from veterinarian practitioners, with pro-castration at higher frequencies for owners of castrated dogs (Chi-square, P<0.001). Overall, most owners disagreed with or were neutral about statements on castration positively affecting male dog behaviour at a population level. Nevertheless, 58% (N = 145) of the owners of castrated dogs (N = 249) reported that correcting unwanted behaviour was a reason to castrate their own male dog. Unwanted behaviour involved aggression in 50% (N = 70) of the owner-dog dyads. Castrated dog’s aggression changes were reported on most as ‘no change’. The second most common answer indicated an aggression decrease in dogs castrated to correct unwanted behaviour and an increase in dogs castrated for other reasons (Chi-square, P<0.001). The increase in aggression in a subset of castrated dogs is concerning, as aggression can pose risks to the dog’s welfare. We acknowledge the limitations of our study which identifies associations rather than provides causal evidence. Still, we recommend professionals’ awareness of possible negative behavioural changes following castration, like increased aggression. Future research on behavioural consequences of castrating dogs needs to build a more solid knowledge base for balanced advice regarding castration.

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.

Cross-sectional survey of surgical techniques used to perform dog and cat spays in New Zealand veterinary practice

Aims: To describe the variation in surgical techniques used by veterinarians to perform routine dog and cat spays in first-opinion veterinary practice in New Zealand, and how these techniques differed with the number of years since the veterinarian graduated.Methods: A cross-sectional survey of veterinarians registered to practice in New Zealand was conducted online between 1 April and 30 May 2018. Respondents were asked their year of graduation and about the procedures, they would use to perform a routine spay of a healthy, 5 kg, young adult, female domestic shorthair cat, and a healthy, 20 kg, young adult, female mixed-breed dog. The number of years since graduation was calculated by subtracting the reported year of graduation from 2018.Results: Overall, 282 respondents provided details about dog spays, and 361 about cat spays, and the median number of years since graduation was 14 (min 0, max 50). Only 54/282 (19.1%) respondents performing dog spays and 43/361 (11.9%) performing cat spays wore a surgical cap, gown, mask, and gloves. For dog spays, 278 (98.6%) respondents used a ventral midline approach and 147 (52.1%) used manual exteriorisation of the uterus. Most used two clamps (168; 59.6%) and used two encircling ligatures (152; 53.9%) for removal of the uterus. For cat spays, 254 (70.4%) respondents used a ventral midline approach and 313 (86.7%) used a spay hook for exteriorising the uterus. Most used two clamps (250; 69.3%) with one encircling ligature (213; 59.0%) for removal of the uterus. Simple interrupted external or intradermal patterns were mostly used for skin closure for both dog and cat spays. For cat spays, the percentage of respondents using the ventral midline approach decreased with increasing years since graduation (p < 0.001). For both dog and cat spays, the percentage of respondents using two encircling ligatures and transfixation ligation of the uterus, and using a simple continuous suture pattern for the closure of the abdomen, decreased with number of years since graduation (p < 0.05).Conclusions and clinical relevance: Veterinarians responding to this survey used a wide range of techniques to perform routine dog and cat spays, some of which were associated with the number of years since graduation. It may be beneficial to provide veterinarians with resources to reflect on their current approaches for performing routine spays. However further research is needed to determine whether any surgical techniques are superior to others.