Humane Alternatives to Veterinary Surgical Training

November 25, 2014  /  Erika Sullivan

Animal Welfare Rotation (March 2005)   -  Erika Sullivan

Alternatives to Traditional Animal Use in Veterinary Surgical Training 

Traditional Animal Use

Traditional Surgical Training Programs:

• USE of animals

- Live animals 

     - Alive on arrival to veterinary institutions 

    - Recovery surgical laboratories (multiple over one or more successive weeks)

    - Terminal (non-recovery) surgical laboratories

    - Numbers of animals used 

• SOURCE of animals

- Purpose-bred laboratory animals 

    - Purchased animals from pounds

• EXPERIENCE obtained

- 3 roles: surgeon, assistant surgeon, anesthetist

Ethical Basis of Concern

• Live animals as sentient beings

- Most people believe that animals are sentient beings - they are capable of a wide range of morally relevant experiences - pain, fear, happiness, boredom, and stress. In this way animals are not unlike humans, but they do differ from humans in that they have no voice to protest about the lives we force them to lead. 

- With traditional surgery use consider: the possibility of fear and stress associated with transportation to veterinary facilities, a strange environment with the introduction of new people and animals; pain, fear and stress associated with recovery surgeries performed by inexperienced students; and a respect for life. Dr. Lara Rasmussen described at an Animal Welfare Symposium, how as a surgeon and a teacher, she required her students to have not only competence in clinical skills, but also an appreciation and respect for life - “The aim was to educate without harm” (Gething 2002).

• “Animals are not ours to experiment on”

- Even if we use animals, animals should live lives that fit their natures. 

- Some argue that the “five freedoms” enforced in the United Kingdom should be minimum standards for these animals, and include freedom from hunger and thirst, freedom from discomfort, freedom from pain, injury and disease, freedom to express normal behaviour, and freedom from fear and distress (Penny and Guise, 2000). 

- Other students argue there are no terms on which we should use live animals - no live animals should be used strictly for educational purposes, especially if the surgery does not benefit the individual undergoing that surgery.

• The large numbers of animals that are euthanized each year 

- A common opposition to use of pound animals is that if they are likely to be euthanized anyways due to pet overpopulation, then students should take advantage of this and practice surgery on these animals prior to their death. 

- In an ethical debate between two vets published in the Journal of the American Veterinary Medical Association, one insisted that it is no more harmful or unethical to subject a shelter animal to surgery before euthanasia than it is simply to euthanize that animal. On the contrary, other vets argue that a dog or cat transported to a surgical facility and subjected to any procedure is stressed, and that animals should not be regarded as mere “tools” of convenience. One vet asks: “Are shelter animals to be excluded from the veterinary obligation to reduce – not inflict – animal suffering?” (Letters 1990).

- Consider the ethics involved in purpose breeding and euthanasia of lab animals for the use in surgical training. A Utilitarian might consider alternatives available to provide equivalent training first, along with the economic and ethical disadvantages to traditional animal use, in supporting a decision in favor of alternative programs. A rightist considers that animals have inherent rights to lives that fit their natures - they are not ours to experiment on, nor euthanize for the sole purpose of educational training.  

• Source of animals

- Pound animals are purchased and fall under different legislation (Animals in Research Act) - The fact that pound animals are purchased may introduce conflict of interest in the pound’s ability to improve animal welfare and in adopt animals out - Alternatives to traditional animal use: inanimate models, ethically-sourced cadavers, and live shelter and/or client-owned - Ethically-sourced cadavers are animals that have died naturally or in accidents or been euthanized for medical reasons. The source of these cadavers differs in that they are often from humane societies, which maintain an ethical promise to the public that no animal that is scheduled for euthanasia will be released to another source alive. This ensures that no undue harm is the result of such action.  

• Humane alternatives already exist and have proven scientifically sound

Humane alternatives already exist that allow students in alternative training groups to be trained in surgery at least as well as students in traditional training groups. This has ethical implications, as alternatives should only be considered if the end result of surgical skill is not compromised, so that the welfare of client-owned pets that new graduates operate on isn’t a concern, and a standardized level of cognitive and motor skill in veterinary surgical training is ensured.

Scientific Basis of Concern

• Superior teaching efficacy and experiential learning can be achieved with alternatives

- Teaching efficacy is demonstrated by the fact that almost every study conducted to date has shown that alternative students perform at least equivalent to their traditional-trained counterparts in knowledge or surgical skills (Pavletic 1994 & Carpenter et al 1991). 

- Teaching efficacy is demonstrated by the growing number of veterinary colleges around the world in which alternatives are extensively and successfully used, and the variety of models that different veterinary schools have to offer. 

- Time savings in alternative programs is critical (recall: in a 3 hour surgery lab almost ½ of lab is spent performing anesthesia). This extra time in alternative programs is spent learning surgical skill, while anesthesia skills are encompassed in additional final year rotations. Time savings allows students to investigate a greater number of surgical variables and combinations of variables than those using real animals. For example, this additional lab time can be used to practice emergency techniques and additional surgical procedures that aren’t incorporated in the curriculum due to time constraints. 

- Students are more able to work at their own pace in an environment conducive to learning applied skill

- Inanimate models (i.e. computer simulations) can be made available at all times, allowing students greater flexibility in their schedules to work on them or even working on them via the internet from home. Major advantages of time savings are enhanced understanding and cognitive + motor skills obtained by students using alternative models of surgical training. 

• Economic advantages

- The purchase, transportation, housing, feeding, veterinary care, experimental anesthesia, euthanasia and disposal of animals (both purchased from pounds and purpose-bred experimental colonies) used in traditional surgical programs can be cost prohibitive, in comparison with the low cost of ethically-sourced cadavers. 

- Alternative models (i.e. computer simulations) offer a cost advantage that only requires an initial investment for unlimited use by students in training. 

• The danger of legal liability and adverse publicity if alternatives are not provided to students who request them.

- Many vet students advocate elimination of live animal surgery in training that does not benefit the individual undergoing that surgery. Their perception is that this reflects poor planning and a lack of concern on the part of their faculty, many of whom may be engaged in animal research themselves (Letters 1990). 

- Universities whose uncompromising attitudes have resulted in lawsuits by students have resulted in situations of conflict and adverse publicity and in some cases have been forced to pay out considerable sums in damages. 

- International human rights legislation and national laws of several countries support the rights of students to conscientiously object to participate in activities that run counter to their beliefs. This is recognized as being an essential feature of a democratic society. Article 18 of the Universal Declaration of Human Rights, proclaimed by the General Assembly of the United Nations in 1948, states: Everyone has the right to freedom of thought, conscience, and religion; this right includes freedom to change his religion or belief, and freedom, either alone or in community with others and in public or private, to manifest his religion or belief in teaching, practice, worship and observance (Knight 2000). 

• Humane alternatives already exist that allow students in alternative training groups to be trained in surgery at least, if not better than, students in traditional training groups

- Numerous studies have been performed to compare the two methods of training in regard to preparation of students for practice. A study by Greenfield et al (1995) examined the development of cognitive skills (understanding how to prepare the animal and table for surgery, understanding how to perform the surgical procedure, problem-solving skills, and understanding the relevant anatomy) and motor skills (draping technique, use of instruments, ligature placement and knot tying, and suturing technique) amongst the students working on alternative models in alternative programs with students working on live animals in traditional programs. Overall students working on alternative models tended to be more relaxed. Faculty supervisors were not able to differentiate model-trained students from the traditionally-trained students, and there were not significant differences in grades between the two groups, making a strong point that students in the alternative program were trained in surgery at least as well as students in the traditional program. 

- Likewise, studies by Pavletic et al (1994) examined employer’s impressions of new grads’ abilities, while comparing students in traditional and alternative programs, and suggested there were not any major differences between the two methods of training in their success in surgery. Alternative-trained grads had at least equal confidence in their surgical skills and were equally successful in completing small animal internships and residences following graduation, indicating that their performance did not appear to be impaired by their laboratory training. All in all, an alternative training program was able to satisfy the moral concerns of the students, yet maintain the quality of their education!

Alternative Animal Use

Alternative Surgical Training Programs:

• USE OF ANIMALS

     - Ethically-sourced cadavers (small animals & large animals)

    - Animals are dead on arrival to veterinary institutions 

    - No animals are euthanized for the purpose of the program

    - Numbers of cadavers used equates to number of live animals potentially saved 

    - Recovery surgical laboratories only performed on patients that benefit from the surgery (including   

               shelter spaying/neutering programs & client-owned animals)

• SOURCE OF ANIMALS

    - Ethically-sourced cadavers

        -small animals: humane societies & client donation programs

        -large animals: slaughter house

    - Inanimate models

- Clinical experience with client-owned animals 

• EXPERIENCE OBTAINED

    - additional weeks performed in final year rotations in surgery and anesthesia

    - additional procedures and practice due to time advantage; unlimited access to inanimate models

    - species variation is broader (i.e. dogs, cats, cattle, horses, ponies, sheep, goats, cattle, etc.)

What are the Alternatives?

Ethically-sourced cadavers, inanimate models (knot-tying boards, carpet padding, foam rubber, yarn to simulate blood vessels, plastic bones, anatomically correct models of abdominal organs, and the DAISE), computer simulations, videos, plasticized specimens, animal shelter spaying/neutering programs, and clinical experiences with client-owned animals; all offer viable replacements for the traditional use of animals.

An ethically-sourced cadaver I trained with. This dog died of natural causes and not for the purpose of the training program.

Advantages of Using Models over Traditional Animal Use

Advantages include the low cost of cadavers, availability of models, the fact that repetition can easily be practiced, models help build confidence in performing surgery prior to performing the procedure on client-owned animals, and models allow student surgical skill development in a more relaxed working environment. Limitations include inherent friability relative to patient tissues (which can be argued as an advantage, as it teaches careful surgical technique), and models do not bleed so students need to practice skills involved in hemostasis and extrapolate these to live blood in ethical recovery surgeries.

Arguments Against Alternative Animal Use

• “traditional live animal use is necessary to teach tissue handling skills”

Tissue handling skills can very well be obtained through practice on cadavers. Plastic soft-tissue organ models such as those successfully used in alternative surgical courses are available. Videos can assist with the teaching of procedure. Certainly whenever studies have been done assessing the skills of students trained using alternative methods their skills have been found to be at least as good as those of their traditionally-trained counterparts (example: Pavletic et al 1994, Greenfield et al 1995, Carpenter et al 1991).  And ultimately alternative tissue handling models prepare the student for live tissue handling through surgical practice on shelter and client-owned animals that actually benefit from the surgery performed, which are important components of alternative surgical training programs.

• “traditional live animal use allows student to appreciate on-the-spot surgical decision-making and appropriate hemostasis”

Models are available as training tools that allow students to obtain experience in ‘on-the-spot’ anesthesia and surgical decision-making, as well as hemostasis. Michigan State University utilizes interactive problem-based anesthesia case simulations to cover a range of different disease syndromes, species, and anesthetic challenges. Likewise, the Veterinary Virtual Ventilator is an interactive computer simulation that allows patients to set up and practice adjusting ventilator settings and immediately observe the effects of the patient. Colorado State University utilizes a fluid hemostasis model that consists of a series of various-sized rubber tubes connected to a water supply and pulsating pumps that simulate arterial and venous pressures. This model allows students to develop psychomotor and blood vessel ligation skills as they practice dividing and ligating the rubber tubing (Bauer 1993). The goals of these models are to provide adequate preparation before anesthesia and surgery are to be performed on live humane society animals and client-owned animals in final year rotations; animals that actually benefit from the surgery performed, and that are an important component of alternative surgical training programs.

• “alternative models lack the biological variability encountered with live animals”

Numerous alternative methods have been used to illustrate biological variability, including ethically-sourced cadavers, plasticized specimens, and videos. The Veterinary Virtual Ventilatoris an example of an interactive computer simulation that illustrates biological variability through consideration of pathological conditions. It enables students to practice setting up surgical ventilators for a variety of patients with various degrees of lung pathology, alter ventilator settings, and observe the direct effects on these patients. Michigan State University utilizes interactive problem-based case simulations to cover a range of different disease syndromes, species, and anesthetic challenges. Patient variability is rewarded when good student decisions are followed by good patient outcomes, but in some cases other problems will develop despite adequate decision-making, just as can occur in real life. Another example is The Ileum from Biosoft, which simulates biological variability through illustrating variability in patient responses to the same dose of drug. Overall, these models along with the inherent time savings in alternative surgical labs, can in fact allow students to investigate a greater number of variables and combination of variables than can be encountered with a single live anesthetized animal.

• “live animal training results in better understanding and retention of information”

If this was true, then it should be apparent in comparative studies of the grades, cognitive skills, and motor skills of alternative and traditionally trained students, and as already stated and claimed through numerous scientific studies, alternative students understand and retain information and perform surgery, at least as well as those trained by traditional methods (Pavletic et al 1994, Greenfield et al 1995, Carpenter et al 1991).  

Did You Know?

A questionnaire was distributed to the 32 veterinary schools in North America in September 1999 and again in August 2004. It was developed to inform students, faculty, and other readers about the curriculum of individual veterinary schools and their use of alternatives to the harmful use of animals. The survey reveals that of the 26 schools that responded, 14 veterinary colleges only offer core alternative surgical programs, were terminal surgeries are not an option in core courses and where spay/neuter clinics at animal shelters are utilized for experience; for example, the Atlantic Veterinary College. All 26 colleges have alternative programs as an option for students in the schools with traditional surgical training programs. What does this ultimately mean? This means that each year in North America, more students graduate having been trained in alternative surgical programs rather than in traditional surgical programs.

References

Association of Veterinarians for Animal Rights. 2004. Comparison of alternatives offered by veterinary schools. 

Available online at http://www.avar.org

January 27, 2005

Bauer, M. 1993. A survey of the use of live animals, cadavers, inanimate models, and computers in teaching veterinary surgery. Journal of the American Veterinary Medical Association;  203:  1047 – 1051.

Carpenter, L., Piermattei, D., Salman, M., Orton, E.C., Nelson, A.W., Smeak, D., Jennings, P.B., and R. Taylor. 1991. A comparison of surgical training with live anesthetized dogs and cadavers. Journal of Veterinary Surgery;  20(6):  373 – 378.

Da Silva, R., Matera, J., and A. Ribeiro. 2004. Preservation of cadavers for surgical technique training. Veterinary Surgery;  33:  606 – 608.

Gething, M. 2002. Welfare issues in surgical training. Journal of Small Animal Practice;  43(12):  572 – 574.

Greenfield, C., Johnson, A., Schaeffer, D., and L. Hungerford. 1995. Comparison of surgical skills of veterinary students trained using models or live animals. Journal of the American Veterinary Medical Association;  206: 1840 – 1845.

Jennings, P.B. Jr. 1986. Alternative to the use of living animals in the student surgery laboratory. Journal of Veterinary Medical Education;  13:  14 – 16. 

Johnson, A. and J. Farmer. 1989. Evaluation of traditional and alternative models in psychomotor laboratories for veterinary surgery. Journal of Veterinary Medical Education;  16(1):  11 – 14. 

Klippert, L., Greenfield, C., Johnson, A., and L. Hungerford. 1995. Veterinary student expectations and outcomes assessment of a small animal surgical curriculum. Journal of the American Veterinary Medical Association;  206:  778 – 782.

Knight, A. 2000. Alternatives to Harmful Animal Use in Tertiary Education. An updated version of Knight, A., 1999, Alternatives to Laboratory Animals; 27: 967 – 974.

Available online at http://avar.org/alted/alts3950.html

March 16, 2005

Letters. 1990. Continuing dialogue on use of live dogs in student surgery. Journal of the American Veterinary Medical Association;  196(12):  1905 – 1908.

Pavletic, M., Schwartz, A., Berg, J., and D. Knapp. 1994. An assessment of the outcome of the alternative medical and surgical laboratory program at Tufts University. Journal of the American Veterinary Medical Association;  205:  97 – 100.

Penny, R. and J. Guise. Animal welfare in the United Kingdom. Swine Health and Production;  8(2): 87 – 89.