The Laboratory versus the Client Owned Animal. Which One Should We Use to Teach Surgery: The Dutch Answer
J. Kirpensteijn, DVM, PhD, Diplomate ECVS & ACVS
Chief, Soft Tissue Surgery Section, Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University
Utrecht, The Netherlands
The Netherlands is often defined in terms of its appeal to tourists (windmills, tulips, wooden shoes) or by its tolerance of different opinions. This tolerance let to the Dutch 'Polder Model' in which parties of different opinion work together to achieve both goals. The history of the surgery laboratory at Utrecht University reflects this 'Polder Model,' and was created in the 1980's and refined during the last 2 decades.
A dilemma exists between the use of laboratory (research) or client-owned animals in training (veterinary) surgical skills. In short, proponents of using laboratory animals claim better end results in surgical skills and more life-like surgeries. These proponents debate the ethics of doing surgery on client-owner animals without proper education. The proponents of using cadaver or inanimate surgery laboratories discuss the ethics of using research animals, the costs associated and debate the real difference between cadaver and live animal surgical laboratories.
During the 1970's, no surgery laboratory was offered to students at Utrecht University. Students were only allowed to assist during surgery and their complete companion animal clinical rotations spanned 4 weeks in total. In practice, surgery was part of general veterinary medicine and its application was rather limited.
The surgery laboratory and clinical rotations were developed in the 1980's to allow a proper training for students in a controlled environment. Dutch ethical morals limited the use of living, anaesthetised animals in these kinds of laboratories. Instead, the general opinion was to expose the students during their clinic rotations to surgical procedures in vivo. The laboratories took place in the 5th year, one year before the clinical rotations and consisted of 16 afternoons. The theoretical background was supplied using lectures. The companion animal laboratory was divided roughly in three parts: basic laboratory, cadaver laboratory and a live animal laboratory. The basic laboratory was used to teach general surgical skills on inanimate models and on large animal intestines obtained from the abattoir. For the cadaver laboratory, dogs were first obtained through necropsy and local veterinarians, but the varying degree of postmortem decomposition limited the surgical benefit. Later, dogs were bought through official dog dealers and euthanatized directly before the onset of the laboratory. One dog was used for every two students. Multiple procedures were performed on these cadavers to limit the number of dogs necessary. The third laboratory consisted of the use of live animals. The intention was that the animal would be allowed to recover to demonstrate postoperative care to the students. The rabbit was used at first, but problems with anaesthesia, analgesia, recovery and skin suturing, resulted in replacement by piglets. The pigs were raised by the nursery of the Utrecht University Veterinary College and surgery under full general anaesthesia was performed at the age of three months. A simple gastrotomy was performed and all animals were allowed to recover and placed back in the facility to be reared. Again, one piglet was used per student pair.
Coincidentally, a discussion on Dutch national television was aired in the mid-1980's, to evaluate the use of pigs in veterinary surgery laboratory. The pro's and con's were weighed by a layman panel and no definitive conclusion could be made on the use of live animals.
During the 1990's, this use of live animals became again controversial and several students who had shown ethical objections to the use of live animals were allowed to rotate through an alternative program in which a feline ovariectomy (OVE) was performed under direct supervision. Around the year 1995, the curriculum of the veterinary school was significantly changed.
One of the consequences was the elimination of the use of live animals in the surgery laboratory. The surgical procedure in the pig was phased out and subsequently replaced by canine cadaver surgery.
Cadaver surgery, however, still necessitated the euthanasia of healthy animals for laboratory purposes and at the end of the 1990's it was decided to replace cadaver surgery with procedures that use inanimate and abattoir products only.
All students rotate through the general surgery course that is divided in three parts:
1. Lectures (maximum number of students 150)
a. Thirty general surgery lectures (large and small animal). The topics vary among problem-solving skills, instruments, antimicrobials, wound healing, emergency management, fracture healing, pain management, physiotherapy, and tumour, abdominal, head and neck, thorax, urogenital and orthopaedic surgery.
2. Interactive sessions (maximum number of students 20)
a. Ten interactive problem-solving lectures: Topics are basic problem-solving (introduction), suture materials and methods, the trauma patient, the tumour patient, the bovine and canine gastro-intestinal patient, urolithiasis, the large and small animal patient with a locomotor problem, and clinical problem-solving (conclusion).
3. Laboratory (maximum number of students 20)
a. The hands-on laboratories are divided according to the following schedule:
i. Methods of injection
ii. Methods of bandaging (large animals)
iii. Methods of bandaging (small animals)
v. Basic suture techniques (dry materials)
vi. Basic suture techniques (chicken leg)
vii. Basic suture techniques (pig bowel)
viii. Basic suture techniques (equine bowel)
ix. Basic claw and hoof surgery (abattoir materials)
x. Basic teat and bovine head surgery (abattoir materials)
xi. Basic ophthalmologic surgery (abattoir materials)
The answer to the question posed at the beginning of this discussion must still be addressed. The Netherlands has not had a history of using live dogs in their surgery laboratory in contrast to many schools in the United States. On the basis of the author's observations, clinical surgical expertise is not noticeably different between Dutch and American veterinary students. This is in accordance with Griffon, et al. (2000) who showed that students trained on cadavers had neither better psychomotor and basic surgical skills nor performed better in a live dog than students who trained on cadavers. Earlier, Olsen, et al. (1996) had observed that a haemostasis model was as effective as live animals for teaching basic skills involved in blood vessel ligation. In general, learning basic skills on inanimate models improves the skill of surgery because the student can focus on the surgical skill itself without being distracted by pathophysiologic conditions of the patient. Further surgical training on client-owned animals, under direct supervision by the educator, is necessary and feasible, without an increased risk to the patient or owner.