Evaluation of an Equine Nasogastric Intubation Model for Training Veterinary Students.

Simulation in veterinary education is an important means of providing a safe, welfare-friendly way for students to hone their skills prior to performing procedures on live animals. Students may not get many chances to practice passing a nasogastric tube and checking for reflux in live horses during clinical rotations and extra-mural studies. A low-cost equine nasogastric intubation model was created at the University of Surrey, allowing students to practice passing a tube and checking for reflux. Thirty-two equine veterinarians evaluated the model for realism, and its potential usefulness in teaching. Veterinarians found the model to be realistic, supported its use as a teaching aid, and provided helpful feedback for possible improvements. In addition, 83 year 4 veterinary students rated their level of confidence before and after using the model for nine specific aspects of nasogastric intubation. Students showed significantly increased confidence levels in all nine aspects after using the model, and reported that they appreciated being able to practice the skill in a safe environment prior to performing it on a live horse. The results of this study suggest that both clinicians and students considered that this model has educational value, which supports its use for training veterinary students prior to clinical placements. The model provides an affordable, robust educational aid that can be used in clinical skills teaching, increases student confidence, and allows students to practice the skill repeatedly.

Proficiency and Retention of Five Clinical Veterinary Skills Using Multipurpose Reusable Canine Manikins vs. Live Animals: Model Development and Validation.

Simulation in veterinary education provides a safe and ethical alternative to using live animals, but most simulators are single purpose and unvalidated. In this study, canine training manikins were created using readily available materials to teach fine needle aspiration (FNA) of peripheral lymph nodes, jugular venipuncture, cephalic venipuncture, intravenous catheterization, and cystocentesis. Undergraduate subjects were prospectively enrolled and stratified by veterinary experience prior to randomization into two groups. Students were taught a new skill each week through a written description of the technique, video training, and hands-on practice (live animal vs. manikin). The following week, participants were scored on the performance of the previous week's skill on a live animal using a standardized rubric by reviewers blinded to the training group. Six weeks later, the assessment was repeated for all skills. Scores were compared between groups and time points using repeated-measures ANOVA after logarithmic transformation. p < .05 was significant. There were no significant differences in scores for any of the skills between the groups immediately following or 6 weeks after training. Initial proficiency and short-term retention of clinical skills do not differ for students trained using a manikin vs. a live dog.

The influence of low-fidelity simulator training on canine peripheral venous puncture procedure.

BACKGROUND AND AIM: Blood collection from dogs is the most commonly performed procedure in the medical clinic. However, different factors can interfere with the quality of the material collected, potentially causing complications for patients. Simulated skill training is a teaching strategy designed to provide early training to students, develop their skills and self-confidence, and increase the procedure's success while reducing complications. Therefore, the aim of this study was to evaluate skill training using a low-fidelity simulator in the peripheral venipuncture procedure and examine the training's influence on the in vivo procedure. MATERIALS AND METHODS: To assess skill training, this study used a low-fidelity simulator in the peripheral venipuncture procedure and examines the training's effect on the in vivo procedure. In total, 100 dogs, 65 undergraduate students, 3 veterinarians, and 4 previously trained evaluators participated. The canine in vivo venipuncture procedure was evaluated both before and after the simulated skill training and the low-fidelity simulator training. Data were collected on participants' self-confidence levels. RESULTS: Local complications occurred during in vivo practice; however, after training, they decreased. Gloves were more frequently used during the procedure, resulting in a reduction of both harvest attempts and complications, as well as increased levels of self-confidence in post-training participants. The simulator developed had low fidelity, low cost, and was easy to create. CONCLUSION: Skill training in peripheral venipuncture using a low-fidelity simulator positively influences student learning, increases their self-confidence during in vivo harvesting, and reduces the complications of the procedure, improving patient well-being.

Development and Validation of a Bovine Castration Model and Rubric.

Veterinary students require deliberate practice to reach competence in surgical bovine castration, but animal availability limits opportunities for practice. We sought to create and validate a surgical bovine castration model consisting of a molded silicone scrotum and testicles to allow students to practice this skill without the use of live animals. We sought to validate the model and associated scoring rubric for use in a veterinary clinical skills course. A convenience sample of third-year veterinary students (n = 19) who had never castrated a bovine were randomized into two groups. The traditionally trained (T) group performed castration on a live bull calf after a 50-minute instructional lecture. The model-trained (M) group received the same lecture and a 2-hour clinical skills session practicing bovine castration using the model. All students were subsequently digitally recorded while castrating a live bull calf. Performance recordings were scored by an investigator blinded to group. Survey data were collected from the students and from expert veterinarians testing the model (n = 8). Feedback from both groups was positive. The M group had higher performance scores than the T group (M group, M = 80.6; T group, M = 68.2; p = .005). Reliability of rubric scores was adequate at .74. No difference was found in surgical time (M group, M = 4.5 min; T group, M = 5.5 min; p = .12). Survey feedback indicated that experts and students considered the model useful. Model training improved students' performance scores and provided evidence for validation of the model and rubric.

Development and Validation of a Canine Castration Model and Rubric.

Veterinary educators use models to allow repetitive practice of surgical skills leading to clinical competence. Canine castration is a commonly performed procedure that is considered a Day One competency for a veterinarian. In this study, we sought to create and evaluate a canine pre-scrotal closed castration model and grading rubric using a validation framework of content evidence, internal structure evidence, and relationship with other variables. Veterinarians (n = 8) and students (n = 32) were recorded while they performed a castration on the model and provided survey feedback. A subset of the students (n = 7) then performed a live canine castration, and their scores were compared with their model scores. One hundred percent of the veterinarians and 91% of the students reported that the model was helpful in training for canine castration. They highlighted several areas for continued improvement. Veterinarians' model performance scores were significantly higher than students', indicating that the model had adequate features to differentiate expert from novice performance. Students' performance on the model strongly correlated with their performance of live castration (r = .82). Surgical time was also strongly correlated (r = .70). The internal consistency of model and live rubric scores were good at .85 and .94, respectively. The framework supported validation of the model and rubric. The canine castration model facilitated cost-efficient practice in a safe environment in which students received instructor feedback and learned through experience without the risk of negatively affecting a patient's well-being. The strong correlation between model and live animal performance scores suggests that the model could be useful for mastery learning.

Evaluation of a Human Virtual-Reality Endoscopy Trainer for Teaching Early Endoscopy Skills to Veterinarians.

Competency in flexible endoscopy is a major goal of small animal internal medicine residency training programs. Hands-on laboratories to teach entry-level skills have traditionally used anesthetized laboratory dogs (live dog laboratory [LDL]). Virtual-reality endoscopy trainers (VRET) are used for this purpose in human medicine with the clear benefits of avoiding live animal use, decreasing trainee stress, and allowing repeated, independent training sessions. However, there are currently no commercially available veterinary endoscopy simulators. The purpose of the study was to determine whether a human VRET can be a reasonable alternative to a LDL for teaching early veterinary endoscopy skills. Twelve veterinarians with limited or no endoscopy experience underwent training with a VRET (n = 6) or a LDL (n = 6), performed two recorded esophagogastroduodenoscopies (EGD) on anesthetized dogs for evaluation purposes (outcomes laboratory), and then underwent training with the alternative method. Participants completed questionnaires before any training and following each training session. No significant differences were found between training methods based on: measured parameters from the outcomes laboratory, including duration of time to perform EGD; evaluators' assessment of skills; and, assessment of skills through blinded review of the esophageal portion of EGD recordings. The VRET was less stressful for participants than the LDL (p = .02). All participants found that the VRET was a useful and acceptable alternative to the LDL for training of early endoscopy skills. Based on this limited study, VRET can serve as a reasonable alternative to LDL for teaching endoscopy skills to veterinarians.

Development and Validation of a Feline Medial Saphenous Venipuncture Model and Rubric.

Cats are extremely popular pets with the reputation of being uncooperative for even common procedures, such as venipuncture. In this study, we sought to create and validate a cat medial saphenous venipuncture model and rubric for use in veterinary training. The validation framework consisted of content evidence, internal structure evidence, and relationship with other variables. Eleven veterinarians and veterinary technicians who were experienced with the procedure evaluated the model by means of a survey. These experienced participants, along with 25 veterinary students who were novices at the skill, performed venipuncture on the model while being digitally recorded. One hundred percent of the experienced participants and 88% of the novices reported that the model was helpful for teaching feline medial saphenous venipuncture. They identified a few areas for continued improvement, including increasing the blood flow rate and decreasing the vessel wall rigidity. Experienced users' rubric scores were significantly higher than novice students' (experienced, M = 13.4; novice M = 16.5; p = .05), suggesting that the model's features were adequate to differentiate the performances of various users. Internal consistency of the eight-item rubric was acceptable at .74. These results supported validation of the cat medial saphenous model and rubric for use in veterinary education.

A Randomized Trial Comparing Freely Moving and Zonal Instruction of Veterinary Surgical Skills Using Ovariohysterectomy Models.

Timely, specific feedback is the most important feature of simulation-based training, but providing adequate instructor supervision is challenging. Students' (n = 76) surgical skills were assessed after training using either the traditional (T) method of large-group teaching by multiple instructors or the alternative method of one instructor assigned (A) to a defined group of students. Instructors rotated to a different group of students for each laboratory session. The instructor-to-student ratio and environment remained identical. No differences were found in raw assessment scores or the number of students requiring remediation, suggesting that students learned in this environment whether they received feedback from one instructor or multiple. Students had no preference between the methods, though 88% of the instructors preferred the assigned method, because they perceived an increased ability to teach and observe individual students. There was no difference in the number of students identified as at-risk of remediation between groups. When both groups were considered together, students identified as at-risk were more likely (40% vs. 10%) to require post-assessment remediation. However, only 22% of students requiring remediation had been identified as at-risk, and A-group instructors were more accurate than T-group instructors at identifying at-risk students. These results suggest that students accept either instructional method, but most instructors prefer to be assigned to a small group of students. Surgical skills were learned similarly well by students in both groups, although assigned instructors were more accurate at identifying at-risk students, which could prove beneficial if early intervention measures can be offered.

Development and Validation of a Model for Training Equine Phlebotomy and Intramuscular Injection Skills.

Simulation in veterinary education offers a solution for bridging the gap between observation and performance of clinical skills. An equine neck model was created that allows repetitive practice of jugular phlebotomy, intramuscular (IM) injection, and intravenous catheterization. The aim of this study was to validate the model for jugular phlebotomy and IM injection. We surveyed experienced veterinarians on the model's realism and the comprehensiveness of its features. In a randomized experimental study, we compared the learning outcomes of first-year veterinary students trained on the model (n=48) and students trained on equine head-neck cadavers (n=45). There was no difference in post-training performance of phlebotomy on the live horse between cadaver-trained students and model-trained students when assessed by a checklist (cadaver 6.87±0.33; model 6.89±0.77; p=.99) or a global rating scale (cadaver 5.23±0.87; model 5.32±0.77; p=.78). No difference was found between post-training scores for IM injection when assessed by checklist (cadaver 6.87±0.34; model 6.89±0.31; p=.76) or global rating scale (cadaver 5.23±0.87; model 5.32±0.77; p=.75). Veterinarians (n=7) found this low-fidelity model acceptable and supported its use as a training tool for veterinary students. Students reported in a post-lab survey that they felt models were as helpful as cadavers for learning the procedures. These results support the use of the model as a component of first-year veterinary student curriculum.

Validation of a realistic simulator for veterinary gastrointestinal endoscopy training.

This article reports on the face, content, and construct validity of a new realistic composite simulator (Simuldog) used to provide training in canine gastrointestinal flexible endoscopy. The basic endoscopic procedures performed on the simulator were esophagogastroduodenoscopy (EGD), gastric biopsy (GB), and gastric foreign body removal (FBR). Construct validity was assessed by comparing the performance of novices (final-year veterinary students and recent graduates without endoscopic experience, n=30) versus experienced subjects (doctors in veterinary medicine who had performed more than 50 clinical upper gastrointestinal endoscopic procedures as a surgeon, n=15). Tasks were scored based on completion time, and specific rating scales were developed to assess performance. Internal consistency and inter-rater agreement were assessed. Face and content validity were determined using a 5-point Likert-type scale questionnaire. The novices needed considerably more time than the experts to perform EGD, GB, and FBR, and their performance scores were significantly lower (p<.010). Inter-rater agreement and the internal validity of the rating scales were good. Face validity was excellent, and both groups agreed that the endoscopy scenarios were very realistic. The experts highly valued the usefulness of Simuldog for veterinary training and as a tool for assessing endoscopic skills. Simuldog is the first validated model specifically developed to be used as a training tool for endoscopy techniques in small animals.