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The use of animals for teaching in veterinary schools is becoming increasingly controversial.
All 28 AVMA-accredited schools have different policies on how animals are used in their veterinary education programs.
Some schools have moved away from the use of animals in their teaching programs while others have significantly reduced the numbers of animals used. Many more are looking for alternatives.
Tufts University has discontinued the use of live-terminal animals in its teaching program. Western University, which opened its veterinary school last month, will not involve live-terminal animals in its education from the onset.
Will these trends compromise the expertise a veterinary student needs to acquire before going into actual practice? Will societal pressures and animal rights activism force a uniform policy on all veterinary schools? The subject begs discussion and promises to pick up momentum in the years ahead.
Veterinary Practice News and a panel of industry professionals opened that discussion at the American Veterinary Medical Association annual convention in Denver in July. Ronald Banks, DVM, Dipl. ACLAM, Dipl. ACVPM; Jan Ilkiw, BVSc, Ph.D.; Anthony Knight, BVSc, Dipl. ACVIM; and Lisa Parshley, DVM, Ph.D.; participated on the panel. Dennis McCurnin, DVM, Dipl. ACVS, and advisor to Veterinary Practice News, served as moderator.
Dr. McCurnin: On behalf of Veterinary Practice News, who's sponsoring this event, my name's Dennis McCurnin. I'll act as the moderator of the session. I used to be a surgeon. I spent 11 years at Colorado State. I'm currently at Louisiana State University, running teaching hospitals for the last 25 years.
When I was in veterinary school at Iowa State University back in the '60s, I always liked surgery. Surgery labs back in those days, there was absolutely zero thought about the animal itself. I'm talking mostly about what the animal felt. It wasn't because we were cruel or we didn't want to be concerned about animals. There were no such thing as animal rights. It had not really been discussed much at all. Certainly, nothing on pain or pain management.
Back in those days, people felt that animals didn't feel pain at times, such as puppies on tail docks or declaw removals. Well, they just didn't feel pain. This thought process lasted for some time because there were certainly surgical procedures done on babies without any anesthetic because they thought that babies couldn't feel circumcisions and so on were done without anesthesia. They just didn't get it. That was the era that I was trained in. When I took surgery lab, it was all survival. It was two people assigned as a group. The group had two dogs usually and those dogs lasted for a semester. You did a surgical procedure once a week on each. and then that dog rested a week and then you did it on the other dog. You did all kinds of procedures, never once thinking, gosh, how about the dog? What are we doing here? We were learning technical procedures.
Then in 1979, I came to Colorado State. I'd been teaching surgery at Iowa State for several years and been in surgery practice for six years in Phoenix. When I came to CSU, I entered a surgery lab at a time when Dr. Bernie Rollin came on the scene about animal rights. I was asked by Dean Femester at the time to become involved in an ethics and animal rights course with Dr. Rollin. I was also doing some teaching in the surgery lab as well at that time. I asked the dean, why did you pick me to do this? I don't have any credentials.
Well, because we need somebody to reign in this class so that we don't have Dr. Rollin running wild because he's a philosopher and he has some ideas that might be carried too far. So we need somebody there as the counterpart and we think you'd be a good counterpart. I was in that class about three years before I figured out what Dr. Rollin was trying to teach because I had no philosophy in college. I did not understand philosophical theorem, nor had I read any philosophical books or been introduced to that subject matter at all. About the third year after hearing the same thing three times, all of the sudden, a few bells started to ring.
About that same time, Dr. Rollin started working in the lab and he thought we were doing too many live animal labs. Said, what do you mean? He said, we don't really need to do this. So I remember we went through a period of time of several years, several other surgeons and I met with Dr. Rollin and we talked about this. There were several other places in the country that were talking about doing non-survival labs. Of course, the big defense was, gosh, if they don't survive, how are you going to know how to recover animals when you get in practice? If you just do surgery on them and then anesthetize them and then euthanize them at the end of the lab, you don't have this experience of recovery, you don't have the experience of post-operative care, post-operative healing, wound sepsis, you lose all of that.
Then it was pointed out, in a teaching hospital, you have an opportunity to see that on real cases under supervision of other veterinarians so maybe you don't need to have all this in surgery lab. When I first heard that, I thought, that's a crazy idea. That's not going to work and it's not going to be good. Then several more years went by and it became evident that the thing to do was maybe we both needed to alter our course a little bit and come up here and see if we can't change things a little bit by working together and that's what finally did happen.
We did find that reducing the number of survival labs was not detrimental to the program. So we've come a long. Now we're talking about maybe making more changes in the way that we use animals. The first question is, how would moving toward a simulated teaching experience affect expertise and knowledge for veterinary students? Is that going to affect the quality of education for the students?
Dr. Ilkiw: Starting off—I have an interest in simulators. I happen to have, for a number of years, had an interest in alternative ways of teaching. I happen to be the person that developed the vascular access models for jugular and cephalic catheterization. And it's always been my dream to have an anesthetic simulator and I actually went to the first simulation workshop in this country, a medical one. It was obvious at that point in time that simulators for veterinary use were just coming into the fore.
They were still in the research labs in Florida and in Stanford and they were just becoming commercially available. There are two different things to know about simulators. There are task trainers and there are simulators. Task trainers are the sort of things like the vascular access model. There's a company, Rescue Critters, that now makes quite a few task trainers for use in veterinary teachings. And those things are designed just to just to teach a task. There's no feedback as to whether the task is done correctly, other than if somebody happens to be there and to talk to the students, but it's just a model that it used. Then the anesthetic simulator or the human patient simulator is the one that is at the forefront for teaching.
The company that now markets it, there's only one company in America, called Meti. That simulator is used for emergency medicine and resuscitation and they have taken that out to teaching in nursing schools and in fire stations and the whole works. And that's a very sophisticated simulator. If you look at teaching surgery with simulators, there's very little that's available, as far as I'm aware. There are no veterinary models at this point in time for veterinary simulation.
I am working with Meti to develop a canine simulator and we hope that we will have that simulator probably 12 months down the line. The thing to realize, if you want true simulators, they are extraordinarily expensive. The human patient simulator starts off at about $750,000. And there's an ongoing need continuously to have somebody who knows how to run that and that keeps it up to date.
Dr. Parshley:I think I'd make one, as far as the students go. I honestly think the students would be happy with any form of education that was put forward to them that would allow them to achieve the skills they need to be a good veterinarian. And if that's a simulator, that's a simulator. If it's a live animal, I think the majority of the veterinary students would use a live animal.
And until you can remove the need for a live animal or a recently euthanized animal from the educational system and convince the students that that is not the best form, then I think the students, in general, would be for animal use. But if you had a simulator, I think they would go for it.
Dr. Ilkiw: One of the reasons why I'm working towards the goal is that I think it then enables us to go back and teach some things that have been dropped from the curriculum because of the decrease. In the number of animals used. There used to be labs where we taught emergency resuscitation. Now, I don't think any curriculum teaches that. And it would be very unusual for many students to participate within a resuscitation within their clinical experience so we're graduating students that really don't have the knowledge. They don't have the skills to resuscitate an animal. That would all change.
If we have a simulator, you can run a resuscitation right through to defibrillation and back again if you need to.
Dr. Knight: The only thing that I'd add is that we'll probably order 100 of those $700,000 machines for our students next year. There are models that can be developed that are way less sophisticated, but that can be used to teach basic skills, whether it be litigation suture techniques, venipuncture and so forth, but again, reduces the need for live animals. I think there's probably some middle ground.
Dr. Ilkiw: I think there's a real need for task trainers. I think Rescue Critters has gone somewhere. I just happen to think that we can do task trainers better than Rescue Critters. I think that they've got to be anatomically correct or they are misleading to students. When I was thinking about the simulator, I sort of said, what's the point of having a Rolls Royce if you don't even have a set of wheels yet. And so what we hope is that as we develop—because the simulator will be a component of—it will be made up of a whole lot of different task trainers. What we hope is that as we develop each part of the simulator, we will feed them off as task trainers, which will be very much cheaper.
Dr. Banks: Dr. Knight introduced a term that I think is probably paramount for a discussion such as this. We see some individuals who learn best by simply reading text, others who can achieve by video observation, others who work better with models or simulations. Still, others who seem best to obtain the information through a demonstration and yet others who must do hands-on.
I know in the research community, we have a number of trainers that we use for things as simple as teaching tail vein injections in rodents, but I will also tell you clearly that the injection through a plasticized rodent tail is somewhat different than the injection through a live, living rodent tail. As someone who has participated in a fair amount of surgery in my professional career, the same argument holds true for canine or other species' tissues. As we get closer to the ability to replace living tissues with plasticized or other simulated devices, maybe indeed, we can replace more animals, but I don't see that in our society at this point the complete removal of animals from an education process as the reasonable or most practical or appropriate way to go.
Dr. Ilkiw: I think you're correct. I think what most schools have done is that they've decreased markedly the use of animals and they've put all of these models that give students a chance to gain a certain level of skills. They gain a certain level of confidence, but then the ultimate goal, obviously, is to move on to a live animal.
Dr. Banks: If we talked in very gross terms of education, the anatomy versus the surgery sciences, anatomy, I'm of the opinion that it can be obtained by looking at either prepared carcasses or even simulations or models. I can determine a muscle or a bone by seeing a representation, not having to have a living tissue. However, if we're talking more of a surgical arena, there are many of those things that, indeed, you must manipulate tissues to be able to find the small ganglia that one may be searching for or the surface or another appendage that may be hidden underneath body fat. And as with everything in life, it takes practice, it takes repetitiveness to become an expert.
At this point, I've not seen those kinds of simulations that would allow an expert surgeon to be able to test out. Certainly, we have individuals who are experts and to ally yourself and become trained with those colleagues is a good thing. Still, one must develop those skills within one's own hands. You can't always rely upon the expertise of others.
Dr. McCurnin: It's interesting that in aviation, of course, they use simulators all the time and I guess pilots probably have a lot of support for that. It's better to crash a plane in a simulator than to go out and try a real one and see if they can do what they need to do, but we're dealing with biological systems and that's why it's difficult to duplicate.
What I'm hearing from the panel at this point is that we have tried and are moving away from the use of live animals in teaching veterinary students, but we have not, in most instances, totally done away with live animals because we've not been able to find something to replace that.
This leads into the second question. How has the reduction in the use of terminal labs affected the teaching of surgery? We'll use surgery as an example here. Are we doing a better job of teaching surgery today than we were? Are we doing the same or worse? As you've said, we are using fewer animals but has it really affected the teaching of surgery?
Dr. Knight: I think it definitely affected the teaching of surgery for the better. One of the things it's forced us to do is define what it is that a new graduate has to be able to do. With the advent of specialists in veterinary practice today, there is a lot of ability out there to do very sophisticated surgery. To teach a veterinary student to do a hip prosthesis or brain surgery or back surgery once in the lab really isn't giving that person the skill and the competence to go out and do that without potentially facing a malpractice charge if they something goes wrong and there happens to be a boarded surgeon right next door. I think that it opens up a whole can of worms.
So I think what's happened and has helped the quality of surgery is that our students end up doing more surgeries than they did in the past because we now involve them in many more spays and neuters, which are surgical training skill exercises. They're live animals and the students get to recover these animals, manage them post-operatively. And I think from the practitioner's point of view, when they graduate and hire a person like that in the practice, they want those skill levels to be up there and the practitioner may then be able to teach other surgical procedures beyond that. The reduction in use of animals has forced us to be very critical of what we can teach and use our limited resources to support that.
Dr. Ilkiw: I think all the schools have changed and for the better. I know that it's probably 12 years ago since we sort of went into a spay/neuter program. At that point in time, it wasn't our complete course. We used to do some exploratory laparotomy labs—animals that were terminated at the end of the procedure. About six years ago, we went to a complete spay/neuter program for core training. It's intensive when we decided to move straight into anesthesia and surgery without the students having any other experience and using animals from the shelter. We divide our year in into quarters and the students work in groups of three, as a surgeon, assistance surgeon, and anesthesiologist. We have one anesthesiologist and one surgeon for every two groups of students.
They're enormously labor intensive to make sure that the students have a very positive learning experience and that the animals have a very positive experience out of it also. Every student does one castration, then we roll into spays. We keep going for another three labs. We'd bring the labs up to about 20 because by then, the students are getting more proficient at doing it and they don't need quite so much supervision, although in the coming year, we are going to drop back to ten and run the lab for three quarters instead of just two quarters. The main reason is to make sure that we can get the supply of healthy animals that are truly adoptable.
Dr. McCurnin: Dr. Parshley, how do you feel about, you know, your experience in surgery lab with reduced animals?
Dr. Parshley: Well, I was still part of Colorado State before the terminal surgery lab was an elective and then we moved into the spay/neuter section of our education. To be honest, I think I learned more in the spay/neuter portion than I did in my terminal surgeries except for perhaps the feel of what it is to incise into a skin and the proper pressure, but for me, I put more pressure on myself in the spay/neuter because I knew it was going to be a survival and an adoption and I think I spent more time preparing and trying to get the most out of it. I suspect, based on comments I've heard from students when we discuss this very issue in our House of Delegates, that it is the same feeling throughout the country that the spay/neuter labs are the ones the students look forward to. One, because they get to be the surgeon and, two, they feel they're doing something morally good.
Dr. Ilkiw: Yeah. I think they've been very positive for not only the students, they're very positive for the instructors that work in the labs too.
Dr. Knight: CSU is somewhat different when we could no longer get dogs from the local humane societies in Colorado. Most of them prohibit the use of any of those animals for use in surgery and research. That forced us into looking at alternative ways of approaching things. We do have an elective lab that is all on pigs. These are pigs purchased from commercial producers and they're terminal surgeries. There are no recoveries from there. But the comments that the students make are, well, these are going to be dead animals anyway and their sort of interest in them is less. They are much more concerned about the spay/neuter and the recovered animal that's going to be adopted. I think there is some element of not taking as seriously the terminal surgeries as they do the recovery surgeries.
Dr. Banks: I find that peculiar as well. I see individuals who are more concerned as you just noted with the pigs versus dogs. As a veterinarian, I wonder what's the difference? They both feel pain. In the research environment, most of our animals are mice and yet I argue that they feel pain too. So just because we move from a surgical exercise of a dog into a lower vertebrate or a taxonomically less mature vertebrate, it doesn't seem to make much sense to me. We're tending to move the actual animal use exercises from a basic instructional environment into a more advanced or specialized environment. As my current practices in a human medical entity, we're doing less with basic students than we did years ago, but we seem to be doing as much or more with practicing physicians on new and specialized techniques. It's made me wonder if it's not also a reflection upon society.
We've talked from time to time about the Nintendo generation that are entering school today. It makes me wonder if those who have spent years with the video activities can relate and respond more appropriately in those matters.
Dr. Knight: Just one comment I'd like to interject that, I certainly did not imply and don't believe that veterinary students anywhere think that using a pig versus a rodent or any other animal, that they don't feel pain or suffer more or less. I think it's more the fact that these are terminal surgeries. This animal, even though you follow procedures, is going to be euthanized versus the animal that is going to be recovered. Intuitively, you're going to pay, subconsciously if nothing else, much more attention to the details and the recovery of that animal. I don't think it's a question of pain. I think today, believe that all animals feel pain and we are certainly very concerned about it.
Dr. Ilkiw: We see in our students different ethical considerations. Some students don't want to do any terminal surgeries on any animal whatsoever. We have some students that don't want to do terminal surgeries on dogs, but would be quite happy to do them on farm animals. And we have the other students that think terminal surgeries on dogs are appropriate for their learning experience. There's a whole gradation there.
Dr. Parshley: We like to think we don't get influenced by the people around us that we respect, but a certain amount of those opinions by students may be reflected because they have this professor they absolutely love in surgery and he is completely against taking away the terminal surgery or the vice versa. And I've just seen people mimic and mime and almost ventriloquist opinions I just heard from either a favorite professor or surgeon. I wonder how much the students' opinions are reflected by that or even their upbringing of their father. Oh, it's just a pig. It's good for the oven, you know.
Dr. McCurnin: I think you've hit on something there that we're all subject to our environment and our personal ethics. That's one of the reasons that we've become a little more aware about ethics in veterinary schools and try to sort out a little more clearly ethical issues, ethical opinions, and maybe methods that we can use in order to resolve these ethical problems. That's been very helpful. There's quite a variety within the student body today, depending on how they've been brought up have quite a varied background even before they get to veterinary school and that certainly affects the class.
Let me go on to the next question. How can the U.K. teach surgery, which they've done for years, because they don't use live animals at all in their program. Is this really a good method? One time, I was there talking to some veterinary students and I asked them about using live animals in teaching surgery. They said they didn't use any live animals. And I said, where do you learn how to do surgery on live animals? Oh, well, we have a spay and neuter program down at the Charity Hospital in London and we rotate through there and we learn our hands-on things there. I said, do you think it's okay for you to do your first recovery surgery on an animal that is going to recover? Would it be better for you to have practiced on one or two animals that are not going to recover because certainly, your tissue-handling techniques, your hemostatis and so on are not going to be as good on the first one or two as they are going to be on the third, fourth, or fifth one that you do.
It was very interesting because everyone that I talked to and asked this question told me the same thing. They said, no, they didn't see it would be any different. That means that every surgeon in the U.K. was taught by somebody who really was never taught surgery by somebody in a veterinary school. They were all taught by practitioners. I pondered that for some time. What I came to believe is that I'm coming from one position and they're coming from another and this is what they've been exposed to.
Dr. Knight: In England, it's illegal to teach surgery on live animals. The way the students there learn is the spay/neuter experience just like they do here. Then when they go out and practice, it's the burden of the employer to train the new graduate. I think that's the major difference between this country and the U.K. The practitioners here expect the university to produce a finished product that is capable of stepping right into the surgical arena, whereas, that is not the case in England.
They have locums, where the new graduates work in practices under the hospices of a licensed veterinarian. Many of them are not board certified surgeons. They are veterinarians, veterinary surgeons, but not of the board certified vintage. They actually practice under the supervision of a veterinarian until that veterinarian says, well, you're now capable of doing something on your own, let me watch you. Then they graduate from one degree of difficulty to another. The big difference is we're expecting education to produce a veterinarian who's able to enter practice and not be a total burden on the practice.
Maybe that's the question that we need to answer. What level does the private practitioner today have responsibility for training new graduates? Clearly, they are way different from someone who's gone through a three-year residency and has board certification, yet they have to work in a practice where surgery is done and they may not have a board certified surgeon there. So is the profession here willing to teach more surgery in their practice? I think the answer is, to some degree, it's kind of happening. We have rotations where students go out and work in preceptorships and go to surgery practices and get to participate under the training of experienced surgeons. The private practice area is going to be more responsible of bringing up the level of surgical skills in our veterinarians.
Dr. Ilkiw: I certainly think that will take a mind change with people in practice because they do expect the finished graduate to be able to go out there without much further training. One of the things that the Californian practitioners said was that they thought our students needed more surgical practice. They said, your students are great at doing spays and castrations, but what about doing cystotomies and spleenectomies and ear surgeries and those sorts of things?
Dr. Knight: If you ask that same practitioner, do you want this graduate to be doing a hip prosthesis, a TPLO, back surgery, the answer is no. Dr. Anne Johnson-from the University of Illinois did a survey. It asked what they wanted an entry-level veterinarian to be able to do first day they enter practice. They had a list of maybe 18 or 20 procedures that ranged from doing a spay, declaws, tail docking, cystotomy, exploratory laparotomy. And it stopped there. They didn't expect them to do TPLOs and more sophisticated surgery. That was something that a person had to gain experience with. So, if we focus on what really the practitioner needs from a new graduate, I think that's what our training program should be.
Dr. McCurnin: I guess we're trying to identify then what the entry-level veterinarian should know. Expectations here are probably different than the expectations maybe in other places in the world. I know at least a segment of the general public will ask why we don't have required internships. hey do with physicians. In medical school, they do not try to teach everyone to be a surgeon and everyone to be an ophthalmologist and a theriogenologist and whatever, but in veterinary school, we try to teach at least basics in all this and then we expect them to be a proficient entry-level practitioner when they go out into the field. That's why I think mentoring is becoming much more important and preceptorships are much more important because it's obvious we don't have a required internship. I saw that as the real difference in the U.K. was they had this assistant program. You were not a regular veterinarian. You were an assistant there, as you say, long enough for an experienced veterinarian to vouch for you, that you were ready now to become a full-fledged veterinary surgeon in the U.K.
Dr. Knight: At CSU, and I believe it's probably the same at Davis and many other veterinary schools, the veterinary hospitals are now tertiary level facilities and we do not see the simple surgeries. I think students are going to have to go out into practice areas to see the type of things that they're going to encounter every day in practice. Our students come very frustrated in my office because they say, I'm not learning to do surgery. I'm watching these procedures and I know for sure I do not want to do. Teach me the things I need in practice.
Dr. Parshley: I pose a question, and this comes at from being privy to discussions I've heard in the AVMA, our curriculum is getting so crowded. I've heard discussions about should this be five years, should this be four years with a mandatory internship? Do you think some of this will change if it does truly get to that point? Do you think we will actually be forced to have a training session after vet school, because of curriculum as opposed to because of animal use?
Dr. McCurnin: I think it could happen, but is it likely to happen? I don't think in the near future. It's two things. It's cost/benefit ratio, what the starting salaries are when you leave the program the way that it is at four years and it's a political question as to how much longer will states subsidize education. They don't want to subsidize it for any more than four years. So I think it would be difficult. Not that we couldn't justify it and not that what you have said is not true. We could use more time. But I don't think that is going to happen.
Dr. Banks: I would go back to the list of 18 procedures that you referred to. Would the survey also ask if those practitioners would be satisfied if the students used simulations or models to practice those procedures? Would that be acceptable for the first day of work? An alternate question might be, what sort or kind of certification would be required for those students to be acceptable on the first day of work? They're apparently not receiving those exercises and activities during the education so it would need to come from some other aspect, process or certification because again, the practitioner wants a financially responsible and productive individual on day 1, not on day 366.
J.I.: Davis is no different. We're a tertiary hospital and our students do a fair piece of spays in their senior year and they do some suturing up of laparotomies and things like that. We actually don't get many students complaining of not getting enough surgical experience, but we certainly worry about how will we continue to teach surgery. One option is to send them out into practice and put the responsibility onto the practitioners. I guess our faculty certainly would prefer to try to train them in-house, if we can find an alternative. That's certainly the way that we're moving—to develop a caseload that will allow the students to gain more surgical experience.
What we want them to do is to get better tissue-handling skills. There's certainly work out there. Let's say that students who do repeated spays. If you give them something different, they will approach that better just because they have more confidence and better tissue-handling skills.
Dr. Banks: A few years ago, when I was still doing some surgery labs, I would usually be relegated the spay lab. What I found was that I enjoyed teaching that lab probably more than any of the labs that I taught. Most of my stuff had been orthopedic before that. I really enjoyed the spay lab because it was a very common procedure. It was something they were going to do and they knew they were going to do it. It was a survival lab. You can teach so much tissue handling, exploratory laparotomy. There are all kinds of things. You can teach so much in that typical "spay lab" that you could not teach in some of these other labs. Maybe it's somewhat the attitude of both the instructor and the student. The more procedures that you can get under your belt, even if they are routine ones, makes you more confident because if you know tissue handling and hemostasis, there's a lot of things you can do.
D.M: What are the economic differences between using live animals and simulated programs? Would schools save money from one versus the other and would this be a reason for some schools that are veering toward one way of teaching?
Dr. Banks: We talked about the use of other species, such as rabbits. I know some of the reasons that, early on, we were using alternative species were that we had a hard time getting dogs and cats. Then suddenly, through USDA changes, they had to come from an approved source so you couldn't just drive around the streets at night and pick up stuff anymore. If you got true lab animal dogs and cats, these animals were costing $600 to $800 a piece. So the dollars were of some concern.
Dr. Banks: One administrator at my institution commenting on the animal use laboratories said it would be cheaper for him to rent the Motel 6 to pay for animal housing at the university. A tongue-in-cheek comment, but an accurate one. The cost of maintaining animals has gotten increasingly more burdensome–in part from regulatory oversight, not to mention the purchase, acquisition, and transportation, and normal daily care. As we put the labor dollars against the project, we provide the animal the kinds and quality of care that it, for many years, has deserved, but maybe has not always received. That certainly has increased the cost of animals.
From where I sit, that has been a motivator to look for alternatives in live animal activities, either in the form of simulations or adding more students to an exercise, using video presentations in some way, if you will, maximizing that animal resource to spread the use or activity out over a much larger group, again, trying to achieve the goal of the training exercise.
Dr. Knight: Unless those simulating machines become much less expensive, I think we're going to continue with pretty well what we have now and that is a mixture of using spay/neuter programs, and providing alternatives to those students who don't want to do terminal surgeries. We use pigs. They cost far less than the purpose-bred dog from the USDA. For now, I see that as our plan to provide both ways to train students. As simulations become less expensive, I could see it asked why we are using live animals.
Dr. Ilkiw: I would hope that when we do get a simulator—that's not going to replace surgery—they will be less expensive, but I can't certainly speak for the company. I think that we've got to get them out there into the veterinary universities so we can teach pharmacology with them. We should be able to teach physiology with them, we should be able to teach emergency medicine, we should be able to teach cardiology. There are a lot of basic skills and knowledge that students should be able to gain in the basic areas before they even move into the clinical areas. As Tony said, anything to do with animals is always expensive. The surgery department has the biggest budget of any department.
Dr. Banks: There's another inconsistency that's troubled me a bit and, for some, this may be a little bit more a motive than you're willing to consider. I'll use the example of the Metro Denver area.
My institution, on a specific year, about two years ago, used far less than 100 dogs in teaching and training activities. During that same period, 15,000 animals were euthanized in the Metro Denver area in a variety of humane shelters and other animal holding activities. Out of 15,000 animals, the institution only needed 100, but since we were unable to go to those sources and utilize those animals, we indeed had to procure the much more expensive animals from a far different and distant source and transport them in.
There are certainly arguments of ethical utilization and humane concerns and people's pets and other things that come into play, but it doesn't seem to make sense to me to have that kind of exercise take place when there are animals just outside the doors whose lives are going to be ended simply because they were unwanted pets. Letting it die that way seems to me to be a waste versus having to raise and breed another animal, buy it, transport it, care for it, for the sole purpose of terminating its life.
There are some value judgments that come in. That's not easy to consider or pleasing to think about, but it doesn't make sense for me to have this animal breeding activity just for the purpose of training when there are many others that are dying senselessly nearby.
Dr. Ilkiw: Sacramento euthanizes 30,000 dogs a year, a huge number. Most of them are pit bulls. We, like a number of states, have gone through legislation that would prevent shelters supplying the university with live animals, dead animals or any animal parts whatsoever, including blood. That was AB588. In fact, didn't get to the legislature. The bill was pulled the night before for lack of support.
D.M: Do you think schools are getting away from the science that we're trying to teach because we have increased alternative experiences for veterinary students? We have increased the amount of business and ethical courses. We talked earlier about how we could easily have five years in the program. Do you think the programs about the same, better or worse than before some of these things were added and changed?
Dr. Parshley: I think as a student, since we are expected to come out and the majority of the class does go right into practice, survival skills include things other than medicine. It's business; it's communication with our clients. If we can't do those things, we cannot actually practice medicine. For example, if we cannot get our client to pay the bill to let us take this dog in who has just been hurt, we are not allowed to treat the dog. Those skills involve communication. If we do not charge enough, our clinic cannot afford to treat that animal. So those are life skills that are critical to our profession and they need to be taught before we ever leave vet school.
I do not think they crowd out our medicine. I think they enhance our ability to do medicine and I think most vet students in the country are actually asking for more.
Dr. Banks: If we look back at medicine over the centuries, we see that medicine as a process has changed. We've just seen a fairly rapid turn in just a few short years. When I graduated Auburn in 1982, I must confess, I had little to no training on communication skills with clients and about the same level of training on business activities in practice. Today, I would argue above and beyond all things that a veterinarian needs those skills so desperately to survive in a practice world. And that doesn't even consider being a success in a practice world. So indeed, those aspects are an important part of, of the education process.
I'm a bit troubled with this concept that after a defined period of time we're ready to do everything else that veterinarians should be required to do for the rest of their career. Every year I learn two more things I wish I learned two years ago. Education has become, for me, a continuum that began in veterinary school and now continues as time goes on.
The struggle I have is trying to define that basic set of skills that you have to survive, to be a success and to be productive for your employer or your management team. I don't know what those are.
Dr. McCurnin: Should there be one policy for veterinary schools regarding these laboratory experiences? Should there be a criteria that would require all schools to teach a certain amount of laboratory experiences a certain way or mandate a certain amount be taught?
A.K: I think if the council of education or some other body would define, or try to define the reasonable entry-level core experience and the core training, that might be helpful, but one policy to govern all veterinary schools would never work.
J.I: It would never work. It's against academic freedom, number one. That's not going to go down well with the university. The other thing is that I think while it may bring some people up, I don't think it's going to forward veterinary medicine at all. I don't think it will help us move forward.
D.M: I remember back in the '80s when we did the Pew studies and Pew evaluations that we, as a body, tried to do was identify what an entry level veterinarian should know. I'm not sure we did it. We talked about it a lot. We had a lot of ideas, but it was very difficult to establish.
If we could establish what the entry-level skills should be of all graduates, we'd then know, I guess, what we should be doing in veterinary school itself, but I think that's difficult. I think we all have our own ideas about what it should be and each school tries to meet that. The AVMA tries to help us by the accreditation standards that are available. The Navale Examination tries to help us a little bit by the types of test questions that they give over the certain areas. One of the cruxes of the problem probably is that we haven't really—and maybe we can never totally—clearly defined what an entry-level veterinarian should be.
J.I: Well, I think that varies and, again, that's why I think that one policy wouldn't suit all. What we have in California is a clientele that has a very high expectation of veterinarians and what they can do for their pets, whereas that expectation may be very different in Iowa or somewhere else. I don't think the expectation is the same. So I think that's what will be very difficult to define: What is the basic level of training? A basic principle at every school is to work out what they think is the basic level of skills and competencies that their graduates will need for the clients and animals they're going to be dealing with.
D.M: Is there anyone in the audience who would like to make any comments about what we have talked about?
Audience: I wanted to clarify the comment that Dr. Ilkiw made about AB588. Actually, the bill was made a two-year bill. It really wasn't defeated. We strategically pulled it. A number of groups that are working on the bill strategically pulled it so that we could deal with the Sacramento County issue, which is the only county in California still allowing animals to be sold from an animal shelter for veterinary training.
Ilkiw: That certainly is correct. It is a two-year bill.
Audience: I had two questions. You mentioned the financial impacts of terminal surgeries, the concern of the schools and the concern about dog and cat overpopulation and how many animals are being euthanized every year in animal shelters. Have any of the schools considered purchasing a mobile surgical clinic? They're only $90,000 to $100,000—that's my understanding and would allow the students to go out into the community and do numerous types of surgical procedures under residency or other people who have surgery training and could teach the students and thereby benefiting the community?
A.K: Somewhat along those lines, the Colorado Veterinary Medical Association has recently set up a mobile clinic like that, in which we hope to be able to send our students to participate. Obviously, our students have to work under the hospices of a licensed veterinarian. We haven't personally purchased one at the university in CSU because we're able to send our students down to the Harrison Memorial Animal Hospital in Denver, where they get two weeks of intensive spaying and neutering. And same with the Boulder Valley Animal Shelter there. So we haven't had to buy our own unit, so to speak. There are things out there that we like to send the students to.
Audience: It seems like there are a lot of opportunities for students to get surgery experience without harming and killing animals. My second question is: If terminal procedures are considered painful procedures under the Federal Animal Welfare Act and the Federal Animal Welfare Act requires that alternatives be considered and the intent of the law is for alternatives to be used, why are the schools continuing to allow terminal procedures to occur when there are plenty of alternatives available?
Dr. Banks: There are plenty of alternatives. I will have to speak in defense of our faculty. I I'm not sure I can agree with them in all situations, but 9CFR, the federal law you reference for the search of alternatives, requires the principal investigator or the principal trainer to consider alternatives. It does not require them to accept those alternatives. And if the animal care oversight body has determined that the trainer has indeed considered alternatives and for faculty reasons has determined that those do not meet the goals of that instruction period, then the training activity does proceed.
J.I: It's not just an alternative. The difference is whether the alternative is equivalent to reaching the goals that you require, that you think are important, that you need.
A.K: I know at our institution, we have decreased the numbers of animals used in training exercises in the last—if I can use the time period of five years—because the faculty have found alternative teaching techniques and methods that they believe provide the same or better training than they were using with the live animals. But that is a decision put to the faculty instructor and not one, at least at this point, that any oversight body or federal body has determined they will make a final decision upon.
I think all universities are required by NIH to have the Animal Care and Use Committee evaluate all procedures, including surgery labs. As far as our university committee is concerned, the fact that animals are under terminal surgeries is not viewed as painful. These animals are anesthetized—they are never recovered and so the pain factor is not an issue in that particular procedure.
Dr. Banks: They are considered potentially painful procedures if the anesthesia's not properly monitored or maintained. That's where I have to, again, speak from personal experience. In our situation, we have either state-licensed veterinary technicians, veterinarians, or other individuals who have been trained in monitoring anesthesia, observe those animals during the terminal exercises. The key watchword is potential. And if anesthesia's properly done, it's not painful. They're asleep.
Dr. Ilkiw: I would have to agree. That's why they're in the animal welfare act, because there is a need for anesthesia to overcome that pain. If you look at the definition of anesthesia or the definition of unconsciousness, if an animal is unconscious, an animal does not perceive pain and it does not wake up having recall of pain. That is the definition of unconsciousness. So as long as, as you said, the labs are monitored appropriately, which I believe they are, and the animals are unconscious, then they are not experiencing pain.
Dr. McCurnin: I think that we all are concerned. This is an important issue: the issue of pain, the issue of doing terminal procedures. As you probably aware, many veterinarians are now seeking animal experience labs. I'm talking about graduate veterinarians. So most of the major meetings held in the United States, such as the AVMA and others, now offer more laboratories.
And these laboratories are all monitored by IOCOOK Committees to make sure that exactly what has been said here happens: that we have complete anesthesia, that we have complete and careful observation during the procedures and that we have proper euthanasia and disposal of the animal once we have finished the laboratory.
I think it's critical in a meeting like the AVMA that even how the animal is cared for after it has been euthanized be treated as very important. We must do these things right or we shouldn't do them. From the standpoint of being the program chair for AVMA, one of the things I have heard over and over again from veterinarians is they want more hands-on laboratories. They cannot extend their experiences in their current settings without proper instruction. So we try to find the experts in whatever laboratory we're offering and make sure we're offering that laboratory in a proper way so that we can conduct it within the level of the law, but also within the professional and ethical levels within the profession.
Audience: I'm curious with the system the way it is now if the animals aren't under a recovery surgery, how are veterinary students learning to recognize pain, to help aid in pain management?
Dr. Ilkiw: I can speak as an anesthesiologist. Our core surgery course is done with spay/neuters and all of those animals are survival animals that go back for adoption. So the students get a very good experience. The anesthesiology labs are in the afternoon, and the students usually finish them about 5:00 or 6:00 p.m. I come back in with the students at 10 o'clock at night.
And the main reason why it's an anesthesiologist at 10 o'clock at night and not a surgeon is specifically for pain management, to make sure that those animals are adequately analgeesed for that night throughout surgery. And then usually they get more pain meds in the morning, but the surgeons take over with the monitoring. So I think that's one aspect of it.
The second aspect of it is during the senior year, the students get a lot of experience working on anesthesia. I have four to six students on anesthesia. And the recovery area is where they spend some of the time. They're responsible for administering analgesics before those animals wake up and then re-administering them, either on a set basis, depending on what the philosophy of that surgeon or medicine person has to be, or else when they think that the animal may be starting to get a little anxious.
Dr. Parshley: Pain is not exclusive to surgery. We are taught from probably freshman year on the signs of pain. Then we get to witness them, in our case, in CSU, starting junior year when we enter the clinics. Our staff is very good—not only the professors but the technicians on guiding us that this animal is in pain and we are going to deal with it. Pretty soon, we, on our own, are recognizing those telltale signs and suggesting it, hopefully sometimes before the staff does.
Dr. McCurnin: I think another place they get it too is all veterinary schools now have intensive care units. And in ICU, you get a lot of experience with managing and recognizing pain. Again, this is a whole other area that has come to light, not only because we're more conscious of it, but because now we have products that will manage pain. We have patches that we didn't have, as an example, a few years ago. With level of consciousness being raised and we now have the products and we know how to use them, we're able to do a better job. I think we've made a lot of strides in this area in the last four, five years.
Audience: With Western University opening up and with the fact that they have the alternative with this mobile clinic, do you feel that the future interests of students who might want to go on to become board-certified in surgery might change? As in, the number of students who would go into specialty practice if they're not exposed to it on an ongoing basis while they're in veterinary school.
Dr. Banks: I had a desire to be a surgeon. I like to do surgery. I was seeking to become a surgeon. I ended up in research medicine. It's a very short story about a very long process. Often in the veterinary field, what I find is indeed so exciting in our profession is that where we begin is often not where we end up. So indeed, to find yourself in one of our boarded specialties may not be where you first started.
It may be a student who wanted to do surgery and ended up in research medicine or a student who wanted to do research medicine and ended up as an anesthesiologist or one of the other specialized fields. I'm not sure that that's going to impact the total outcome, in terms of the numbers of, of veterinarians that we have in each of our specialties. It actually may be an enhancement as it opens our eyes to other aspects of our profession.
Audience: I had a traditional surgical training in veterinary school 19 years ago and yet I still felt completely ill-equipped. Most veterinarians I know feel like their first year out was their training year anyway. So whether I had one part of a hands-on experience or not in veterinary school really didn't make a difference to me. All of my training, I felt, came at my first and every year since I've graduated. So I'm glad to see that we're moving away from that surgical training anyway because I didn't think it was as useful as my first couple years out.
Audience: Hi. I'm Crystal Spiegel from the American Anti-Vivisection Society. I have a question for those faculty at schools that continue to use terminal surgeries. Have you discussed with faculty at other universities that have eliminated terminal surgeries this issue and have you been impressed by their experience? I know Tufts University and University of Pennsylvania Small Animal Hospital, neither of them include terminal surgeries in their elective or core curriculum. So I wondered what your impression was of those universities. Unfortunately, there's no one really to represent them. And maybe address why you haven't made that move and if their experience might help you to move in that direction.
Dr. Banks: I will answer your question, but I can't entirely do so in the first person. I'm serving at a human medical school and I don't teach medical students. I support those activities. I can tell you that our faculty have had many discussions in that regard and have considered what activities are occurring at other institutions across the country.
I think I heard the term earlier in this evening's discussion of academic freedom. And indeed, that is something that is quite sacred to faculty in all of our institutions across the country. They have a goal in mind. That's to teach the knowledge set of skills that they have in front of them and they wish to do that in the most effective and practical manner possible. It is my opinion that some faculty believe that that can be done one way better than another. Whether that opinion remains the same in their minds over many years is probably not true.
I refer again to our example of the last five years where the numbers of animals at the institution have gone down as faculty have converted to other simulations or other types of training modalities. And probably that's going to continue in the years ahead, as some of the simulators and models and alternative systems become more exquisite, we may indeed see less numbers of animals being used. We need to be cautious, I think, about looking at a national standard for instruction. While we have national testing skills or national testing criteria, I guess I should say, to have national instruction seems a bit problematic, as we have a number of different faculty in varied environments, varied institutions, with various requirements and various needs.
Dr. Ilkiw: Oh, I agree. I think that various schools do various things for various reasons, sometimes not always known. So I think, then, you have to be careful about putting those schools up and saying that everybody should follow. I think that from our point of view, competency and proficiency for our clients and their animals and their expectations when they take their animals in are important. We continually discuss our surgery curriculum. We continue to implement changes, but we do want to make sure that's not at the expense of competency. That when somebody brings an animal in to one of our graduates with an expectation that that owner will not be disappointed and that animal will not be harmed.
Dr. Knight: I think the change is happening. It doesn't happen overnight. Five years from now, I think you'll see a significant shift to alternative training methods that don't involve live animals at all. And some of it will be dictated by society. Society will pass laws that prohibit the use of animals for that purpose. Local municipalities are already doing that.
Our surgeons are opinionated. I'm not a surgeon so I can say that, but they have different opinions as to the best way to train a student. A couple of years ago, Dr. Mike Bower and Dr. Mary Carpenter did a study where we took 30 students who refused to use animals or euthanize animals for their education. We took the other students who were happy to do the terminal surgeries. We used cadavers that came from the humane society; these were animals that were going to be destroyed by the humane society. Then they did the same procedures, one on cadavers, one of these terminal-live animals. We videotaped both groups just showing the hands, doing the procedures on live animals, doing the spay and had a variety of criteria. We had three surgeons who were blinded to whom the people were.
Statistically, there was no difference in the outcome of that procedure. So that started the shift for us to say, well, this is not necessary. But there are some surgeons who still feel the live-animal experience is the best in terms of training a person to be a surgeon. So n my opinion, five, 10 years from now, there will probably be very few schools that retain live animal labs.
Dr. Banks: We should also keep in mind that, I believe, there's not a single educator whose goal it is to kill an animal. The goal is to teach a skill set, a knowledge base. It is unfortunate that sometimes that may be the end result, that an animal may have to be used to accomplish that, but sometimes, at least from where I sit, I get the perception that, that some of our community and society believe that the real goal of education is to put a beast to death. And that's not it at all. It could not be further from the case. There just does not appear to be, to that faculty member at that particular point in time, a better method of teaching what must be taught.
Dr. McCurnin: I think we are in a state of certain evolution. I can remember a number of years ago that one of the veterinary schools went to a computer-assisted teaching mode in which they decided that they really didn't need to use a lot of lectures; they could do it via the computer. And with any kind of a change, whether it's not using any live animals in the teaching program or trying to reduce the number of didactic lectures and using electronics, it takes a while to evaluate that.
In the case of the electronics one, after a period of years, they decided that maybe there's a better way to do it. So they now use a combination. I think in the lab areas, we certainly are continuing to experiment and be inventive and trying to be a little bit visionary, but sometimes it takes time to do that. I think all the schools are going to be watching Tufts and Western to see in the next four or five years how their students then compare with the more traditional training.
If, in fact, there is little difference—and one would believe that that might not be the case—then I think you'll have more people buy in.
I think that a lot of the things that are done today are done because the faculty who make up the curriculum committees and the schools come from different backgrounds and their experiences have a lot to do with it.
Dr. Knight said he wasn't a surgeon. Well, I am a surgeon and I know I feel certain things only because I was trained and went through certain processes, where Dr. Knight had another experience and feels something different. It doesn't mean that I'm right and he's wrong or vice versa. It means that we're trying to get to the same end goal maybe a little bit differently. But I think there are changes afoot. They're going to continue. I think having discussions like this will further this cause because we bring the issues up in front of the profession. And I think that publishing this information through Veterinary Practice News will help, hopefully, the entire professional hear a little bit more about this information.
We've had some good questions from the audience. I would like to thank our panel, Dr. Banks, Dr. Ilkiw, Dr. Knight, and Dr. Parshley for being open and interactive during this session. I certainly would like to, again, thank Veterinary Practice News for sponsoring this event.
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