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Ethics of Surgery by Pre-Vet Students During Volunteer Work

Discussion in 'Pre-Veterinary' started by alliecat44, 11.28.10.

  1. alliecat44

    alliecat44 KSU CVM Class of '11 Moderator Emeritus

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    A tangential discussion occuring on the VIDA thread has to do with the morality/ethics of pre-vet students performing surgery in other countries as part of voluntourism efforts to control pet populations: http://forums.studentdoctor.net/showthread.php?t=767890&page=2

    Starting a separate thread at twelvetiger's request. :) Please post here rather than there. Thanks!
     
  2. bunnity

    bunnity Penn 2014

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    Thowing my vote in for the "don't think pre vet students should be doing surgery." There is a reason that only doctors and vets are allowed to do surgery. Because they understand the anatomy and the physiology. I have only been in vet school one semester and I can't even start to explain how much I have learned already. We had a good three hours of lecture on blood clotting and we haven't even made it to physiology yet. We have learned every part of the female and male reproductive tract, how it is attached to the body, and what innervates it and its blood supply and how it develops, and we are still going to have repro classes and surgery classes in the future. And from anatomy lab, I can't tell you the number of arteries and nerves I've accidentally sliced. And that's on a dead animal that doesn't move, breathe, or bleed. And I am a good dissector. I just don't see how it is a good idea to let people with a dream and a scalpel start cutting up animals.

    Would you do it if it was your pet? Then don't do it on someone else's.

    I also have objections to paying thousands of dollars to participate in a spay neuter clinic - why not just come to Philadelphia where there are many to choose from, running 365 days a year, and we are still killing 16k animals a year. And you probably won't get food poisoning. And it's free.
     
  3. StartingoverVet

    StartingoverVet Flight Instructor for hire Gold Donor

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    Under the supervision of a vet is under the supervision of a vet. What difference does it make if the person under supervision is pre-vet or vet student. They aren't licensed veterinarians.

    I can go do neuters as 1st year at local animal shelter (under supervision) but I know probably a lot less than TT among others. Sept 1 next year I can do spays as a 2nd year and will still probably know much less than many on that VIDA trip. So what. I assume the supervising vet is there to make sure things go as they should.

    When I was a volunteer in America I assisted on TPLOs. Do I think I could do one on my own? Of course not. I knew the procedures (rapidly forgetting a lot), could handle the drill etc, but it was meaningful experience. Still, the vet was in charge the whole time.

    I just don't see a big difference.

    And honestly, they are training non-vets to do spay/neuters in a number of developing countries because more animals will die due to overpopulation issues than will develop complications from the surgeries. It is a "good of the whole" decision.
     
  4. 4paws

    4paws

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    Just wondering.....for those that have gone on these trips before, how many of you already had the 25 hours of observation and how many went to a clinic and were granted permission to observe for the purpose of the trip?
     
  5. 168135

    168135

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    I had well more than 25 hours from volunteering in highschool. After I went to university and stopped being a volunteer, it was difficult to get into that clinic to shadow. I called them, played the "I'm going to Central America and need to observe 25 hours of surgery" card. They let me come in for two days and signed off on my hours.

    I volunteered on and off at another clinic in he city where I attended university. I played the same card and they let me come in every Friday for three months prior to my trip to watch surgery.

    I'm not sure how many hours I had in total. Even though the first vet signed off on my hours, I wanted to do some more shadowing since I knew what I was about to be getting myself into. Once I realized I was going on the trip, I had a LOT of questions that needed answering :p
     
  6. scb44f

    scb44f MIZ c/o 2015

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    I already had more than 25 hours, but talked about the trip with the vet that I had shadowed the most (and have continued to shadow the most since). He signed off, but I observed plenty more hours between when he signed and when I left for the trip.
     
  7. Tco87

    Tco87 Illinois 2016

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    I spayed both of my cats while I was an undergrad. I was under the close supervision of a vet the entire time. There were no complications during or after the surgery and if anything had happened, I know the vet would have stepped in. My views are largely colored by that experience, but I don't think that having pre-vets performing surgery under close supervision is any more immoral than having vet students do it.

    I agree with what SOV said, if they're under close veterinary supervision, that's what really matters. If this were a matter of them being thrown in room with no help or only superficial help, then I could understand why people are getting so upset about it, but I honestly believe that what VIDA and similar organizations are doing is beneficial to the animals and communities.
     
  8. dee vee emm

    dee vee emm Future DVM

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    I had about 5 years' worth (part-time during school and full-time in the summer) and counting of working at a small animal clinic and watching the surgeries... so yeah wayyyyy more than 25 hours!
     
  9. sunshinevet

    sunshinevet

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    The biggest difference between a pre-vet and a veterinary student is knowledge. A veterinary student should be able to recognise all the internal structures and differentiate them from each other. A prevet only knows because someone told them "this is this and this is this" and quite frankly, that is not enough knowledge for me. Unless veterinary students have completed anatomy and surgical skills classes, I don't think they should be performing surgery either.

    Look at it from a human perspective. What would we think of premeds going to third world countries and performing surgeries there, and paying for the experience? I think most people would think it was a bit unethical. Since the veterinary world is always complaining that we don't recieve the same respect etc as the human med world, maybe its time to step it up a bit???

    Also, if you are recieving such close supervision on the VIDA trip, as is every person who isnt liscenced and performing surgery, makes me think it would be quicker just to get a really experiences spey/neuter vet in there and do the job of three volunteers. I'm sure you guys get a lot of experience or whatever... but you're still going to be slow. REALLY slow, compared to some of these vets. Surely it would be faster/more cost efficient just to get the vet to do the surgery. And safer for the patient, too!!!

    Also, here in Aus a licensed vet nurse can perform a neuter - as long as they do not enter a body cavity, and they are under the supervision of a vet. I do not have a problem with this. But a spey is a different beast entirely - you are in the abdominal cavity, you are dealing with large blood vessels, you have to watch for your ureters etc etc - I definately DON'T feel comfortable with an unexperienced person speying. It IS a complex surgery that can go very very wrong. And I think most of those people who think its ok for inexperienced people to do speys, are people who are just really excited that they are allowed to do a spey.
     
  10. 168135

    168135

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    A lot of people have brought up some very interesting about supervision, techniques, complications, etc. I don't think it's okay to say that all volunteer trips are unethical and don't accomplish anything until you've seen first hand how the clinics are run and how the communities have changed since the program.

    You can brainstorm a million little things that could go wrong with a spay or with an "inexperienced" student taking the reins but it's wrong to sit there and assume that everything goes wrong and that the communities are suffering from it.

    Maybe someone should go down there, spend a significant amount of time in that community, follow up on the cases and THEN come up a conclusion on whether or not these programs are beneficial to the students, the animals and the communities.

    I volunteered at a clinic where they don't even change their gloves between surgeries and use the same instruments. The VIDA clinics have 1 up on them there.

    Also, a lot of members in the community picked up strays, claimed that they were owners, and brought the animals to the clinic to be fixed. At one of our clinics in Costa Rica, there were several stray dogs hanging around the clinic. They were all examined/fixed/vaccinated/treated for parasites by the time we left. How often do you see happening in North America? I never see it here. There are a half dozen stray or wandering cats on my street alone. The SPCA won't touch them because the government doesn't give them funding for cats. The people in my neighborhood are lazy and won't even get off their butts to take them to the shelter, let alone spend $150 to fix them. If they're considered low-income, the SPCA will pay most of the cost so that it's $50 or less. People still don't do it.

    That's 2 for VIDA.

    I'm actually pretty curious to see what their track record is. Given the conditions, I'd like to see some numbers reguarding complications, and I'd love to find out more about how the program is impacting the communities. Once I get my DVM (fingers crossed), I'd like to return and put it all into perspective. Yes, I've been on the trip, but I'm really not qualified to tell people that the clinics are awesome, complications rarely happen, and the animal population is on the decline. All I can say is that I had a great time, learned a lot, got a lot of hands-on experience and it makes me stand out from the other applicants.
     
    Last edited: 11.28.10
  11. turquoisewolves

    turquoisewolves c/o 2015

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    Well, as a person seriously deciding whether to attempt one of these trips I have been pondering the debate you guys started. I actually really appreciate it because I never thought to think about any of this in this light before. It has forced me to do some research and try to form my own opinion so that I can be able justify my position once I decide upon it. I believe that I am leaning towards SOV's opinion.
    But I have a question, on the AVMA Policy of Veterinary Technology it states:
    ...."These duties shall not include diagnosing, prescribing, or performing surgery except where explicitly permitted by regulation."

    What do we think would be the "explicity permitted by regulation" surgeries...and legally it doesn't even state that it would have to be under the direct supervision of the veterinarian when most technician duties are just to be under the "direction" of a vet and they are held responsible for the techs. As I am obviously not in vet school yet, I haven't a clue as to what procedures this would be alluding to???? Ideas?

    And then I started looking up the different State Legistaltive Resources through AVMA and that really gets confusing with their vague definitions of what is explicitly veterinary medicine vs. "exemptions". So if it differs by state here in our own country whether a lay person can/cannot "legally" float teeth or castrate their horse, I can't decide if I see anything wrong with acknowledging that an entirely different country has a different set of regulations that they ethically justify when IF I ever get to be a vet I could have to obey differing rules according to the state I end up wanting to practice....let alone a different country which I saw someone on the "Questionable procedures" thread said that somewhere declawing was illegal altogether (a whole different debate....but it all kind of ties together).

    ANyway, I know that I have A LOT to learn since I'm not in vet school yet after which might very well influence my opinion.:)
     
  12. breenie

    breenie Weenie 2015

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    I was told by some pre-vet girls at my school who did VIDA trips that they used zip ties for spays (wtf?) and did surgery on top of trashbags.

    They seemed to think this was hiiiii-laaaaarious. There was definitely some giggling about lack of sterile technique and poor suturing. Why they were giggling about this is beyond me, but whatever.

    Maybe not all VIDA trips are the same? I don't know. But that sounds pretty horrendous, and I don't want people with that attitude anywhere near an animal with a scalpel in their hand, 3rd world or not.
     
  13. EllieGirl89

    EllieGirl89 Ohio State CVM c/o 2015!

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    I don't want to get in on this whole thing, but just playing devil's advocate--there are a LOT of things we do to animals that many consider acceptable that would be considered unethical to do to humans. We freely buy them and sell them, keep them for our own pleasure, use them for our entertainment, kill them for our food, and test our products on them before they're tested on humans.

    Going further into your analogy, there are even things we do just narrowing it down to the realm of human vs. veterinary medicine. Euthanizing an animal that is near death is very widely accepted; the idea of human assisted suicide or euthanasia is often met with strong opposition. We regularly spay and neuter our pets as a means of population control and some animal shelters even require it; to require humans to be sterilized as a means of population control would probably not go over well. And the list could go on.

    Your parallel is a convenient one to draw but I'm not really sure you can compare the two in this case. Just some food for thought.
     
  14. nyanko

    nyanko all i do is win Gold Donor

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    That's actually a really good point - there is very little screening for people who go on these trips beyond whether the check clears and they could have a vet sign that they watched surgery for a month or so.

    At least veterinary students, vet techs, etc...others that are being talked about in this thread, have been somewhat screened or tested before they are allowed to pick up a scalpel and perform any type of surgery.

    edit: By that I mean that anybody can call themselves pre-vet, so the designation itself means pretty much nothing.
     
  15. bunnity

    bunnity Penn 2014

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    #1 A crappy North American clinic not using sterile technique doesn't have anything to do with what's ok in another country.
    #2 At my old job I saw it all the time. Twice a week to be specific. Google TNR.
     
  16. alliecat44

    alliecat44 KSU CVM Class of '11 Moderator Emeritus

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    :thumbup: :thumbup: :thumbup:

    Okay, so my views as articulated on the other thread are pretty darn clear. However, the following quote from a PM I sent earlier seems to particularly address SOV's point of view that supervision is supervision, so I'll reiterate it here (and then I'll try my darnedest to keep my mouth shut for a while!) :)

    I was a technician in specialty practice for ten years prior to veterinary school. In fact, I worked in a specialty surgery practice for three years and scrubbed in on everything from thoracotomies to craniotomies to total hip replacements. And I'll tell you--even though at one point I scrubbed in on 10 cruciates a week and could close my eyes and recite to you every single move the surgeon made--I would NEVER have thought myself capable of performing the surgery. How did I know what landmarks he used? How did I know to make the incision this big, but not this big? This lateral, but not this far lateral? How much tension to put on the tissues? What anatomical structures are we worried about at each layer of dissection and manipulation?

    Before we performed our first spays in veterinary school, all of us watched...and re-watched...and re-watched...a 45-minute step-by-step instructional video. I'd imagine that I watched the entire thing myself about 10 times start to finish, comparing it side-by-side with my lecture notes and anatomy notes, and was absolutely terrified. My first spay took me THREE HOURS. You know why? Because I knew ALL of the different reasons to respect the situation and the potential pitfalls. You are exceedingly careful when you are more informed about what can go wrong.

    Merely following the equivalent of an IKEA instruciton manual--cut here, don't cut here, clamp here--scares the living daylights out of me. Performing surgery is not like putting together a desk. There are many, many things to think about at each step of the game.

    And, I do have to question the motivation behind these groups when the veterinarians could be sterilizing MORE animals if the pre-vet students were utilized as technical staff instead of surgeons. I did an externship at a high-volume, low-cost spay/neuter group and we literally did 35-45 surgeries per day with a single surgeon. (And after that week, I can finally spay a dog in 45 minutes.)

    This is why I personally have a problem with technicians and non-licensed people performing surgery. I value my (forthcoming) license to practice veternary medicine, and there's a reason why that license allows some of us to perform some procedures that others cannot.
     
  17. No Imagination

    No Imagination I

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    I dunno about that. I worked as a tech for 6 years, and when I was doing that, I was far more capable then i am right now (as its been nearly 8 years since I worked in a clinic). Sure, i know more technical knowledge, but I've lost most of my practical skills. As far as recognizing internal structures... when I was a tech, I knew when I had the uterine horn, now, I have to spend 5 minutes figuring out if its GI or not... I would rather have a good tech perform the surgery over a 2nd year vet student who knows what to do, but perhaps never actually did it.

    My fiancée is a 3rd year med. student, and they have similar trips, you would be surprised at what they do!
     
  18. 168135

    168135

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    I'm quite positive that my two vets wouldn't have signed off on my hours if they considered me immature or incapable. I only spent two or three hours a day in surgery... which adds up to 10-12 visits for the 25 hours. If they didn't have some idea of my character after 10-12 visits then they must be blind or something.

    Anyway... those girls are idiots. I highly doubt that most volunteers are that immature. I wish them the best of luck getting into vet school :rolleyes: They probably still giggle at the word "penis".

    A majority of the people on the trip were employeed at some point at a vet clinic, have volunteered, were vet students, or vets. Nobody came in there with just 25 hours of surgical observation.
     
  19. 168135

    168135

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    I know what TNR is. It's still fairly new here. I only saw two TNR cats in the last 5 years. Next week, I will be seeing 10. My vet agreed to provide 10 surgeries for free to clients who have a stray cat problem in their area. Apparently there is a TNR organization in a nearby town, but I've heard NOTHING about their efforts since I started university here. I tried to get in contact with them to volunteer and that was a fail. And now their website isn't functioning. I wonder where they went?

    Maybe I should start my own TNR organization here. I donno :p
     
    Last edited: 11.28.10
  20. breenie

    breenie Weenie 2015

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    Those girls are decent students at a large public university and will likely be applicants to our state's veterinary school within the next year or two.

    Stranger things have happened.
     
  21. lizinwonderland

    lizinwonderland

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    .
     
    Last edited: 11.17.14
  22. twelvetigers

    twelvetigers Throw the ball throw the ball THROW THE BALL Gold Donor

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    It's under 'in the trenches' and doent actually mention VIDA at all.

    And no, people, I don't have a VIN account. Someone (not on this forum) forwarded me the thread.

    Try searching for 'volunteer perfom surgery' or perhaps 'studentdoctor.net' to find the URL in the thread (not sure how their search engine works).
     
  23. lizinwonderland

    lizinwonderland

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    .
     
    Last edited: 11.17.14
  24. Minnerbelle

    Minnerbelle Moderator Emeritus

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    I'm kind of in the middle on this issue, but leaning more towards the "I wish VIDA and similar programs would be much heavier on their volunteers gaining tech experience rather than surgery experience" camp.

    I think there's really 2 issues at hand here. The first being whether or not laypersons should be performing surgery, and the second being whether or not these trips are really meant to benefit the pre-vet volunteers or the animals/communities in the third world.

    I can't comment much on the first issue with much authority... since I'm not much different from a pre-vet, seeing as I hardly have a semester down and don't feel that much more knowledgeable about spaying/neutering than when I was a year ago. But legally, at least in CO I'm allowed to start doing so under the supervision of a veterinarian. Even then, I don't feel like it would be kosher for me to go in after a few surgery club wetlabs and surgery skills lab, and have a vet guide me through a spay. However, I think it would be totally ethical for me to observe vets performing spays/neuters and start practicing little snippets at a time. Depending on how many opportunities a first year gets doing that, I can see one slowly doing a neuter him/herself and working up to a spay. So in that sense, I don't think pre-vets are any less capable of "mimicking" spays/neuters under the supervision of a vet than a 1st year vet student like myself.

    Regardless of who's doing it though (pre-vet, 1st year, 3rd year, etc...), someone who's performing their very first surgery is going to cause more suffering on the animal by not having a seasoned vet do the surgery. Then what's the difference? I would say it's justification. Unless one fails out of school, a vet student is going to become a veterinarian in a few short years and needs to learn how to perform surgery somehow. The only way to do that is to practice under the guidance of a veterinarian. No matter what, animals are going to have to be subjected to my learning if a vet student is to become a competent vet.

    Yes, it's true that many of the pre-vets who go on these trips will eventually become veterinarians (esp those on this forum), but as others have said there's really no screening process for pre-vets. Anyone can designate themselves as one. I think it's justified to practice on animals under supervision in order to become a better vet... but I think it gets a little murky when it's for the "experience."

    But like I said, I agree that if a veterinarian is right there, and watches and instructs each step... for the most part, the result will be a live and kicking sterilized animal (in variable amounts of pain)... and given their circumstance in the overpopulated world, it's not the worst thing that could have happened to them. I totally see that point of view, and I think it's a matter of perspective to believe it's ethical or not (for the record, I think unethical but I can see why some would justify it).

    The bigger issue I have is the latter of the two. Like others have said, it's pretty common for a spay/neuter vet to do a good 30 surgeries in a 6 hr span. If you had just 3 veterinarians working 10 hrs a day, they could have knocked out a very conservative 100 surgeries a day (A program at CSU does this, and they knock out well over 700 surgeries in a week). It would take AT LEAST 3-4 great volunteers/vet in order for the volunteers to have animals knocked down, vaccinated, and prepped for the surgeons to have animals constantly at the ready. I'd bet that this would work out even if one vet was designated the non-surgeon who saw appointments throughout the day. Spay/Neuter vets are FAST and it's very difficult to keep up with them... and perhaps the org would be more successful at recruiting more of them if they were the ones doing what they do best, instead of teaching laypersons (which many vets have issues with).

    And I understand that when you're a non-profit in the 3rd world, you don't have optimal equipment/protocols... but why on top of that would you add inexperienced hands and prolonged surgery time? The program has perfectly capable veterinarians on site... so why do the volunteers have to perform surgery? That's what I don't get. Because they paid money and flew out of the country? Because without money from the volunteers, the org doesn't have funds for this trip... and 50 animals is better than none? Could this org just not recruit enough paying volunteers if they offered an intensive tech crash course instead of a surgery crash course?
     
    Last edited: 11.28.10
  25. bunnity

    bunnity Penn 2014

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    I like your whole post but definitely wanted to echo how efficient an experienced spay surgeon is. At my old shelter there were two of us tech-ing and we could barely keep up with her (and the PEs / vaccinations / dewormers had already been done by someone else). She could do 30-50 surgeries in 8 hours (and she was doing a good job). At the TNR clinic I mentioned before, they would have 1 surgeon and they were probably doing 50 cats a day. It does seem more efficient to have the vets doing surgery and the helpers helping.
     
  26. 4paws

    4paws

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    The reason I asked about having the hours is not because I think having more than the minimum makes anyone more capable, I just wonder how much support one would get from a vet if they told them the trip was the reason they needed observation hours. I'm thinking it's easier to get someone you have a history with to sign off on something like that. Others have been refused because there are vets that don't agree with this. May also be why there are open slots for vets on every trip.....

    My take on this issue is this- experience AND formal training make a person capable of performing surgery and recognizing the significance of every step that's taken. And not just the ones with surgical instruments, but what you recognize with your eyes, problems you can prevent with your techniques (pre and post-surgery), and ensuring that you cause as little damage as possible.


    Are there new grads that shouldn’t be performing surgery alone because of lack of experience? Sure. Are there people that shouldn’t be performing surgery due to lack of formal training? Definitely.


    I can appreciate that those who have gone on these trips are enthusiastic and defensive (for lack of a better word). I’m not so sure I would’ve disagreed so strongly a few years ago. It has the potential to be a great experience/program.


    I wish all the pre-vets the best of luck on getting into schools, but I ask/hope for this: Somewhere along the way, come back to this forum and re-read the statements that say…..knowledge of anatomy only goes so far….. that paying to perform surgery before you have any formal training would be widely accepted in the veterinary community (esp. with adcoms)…..that “training” can come in the form of an info packet and an afternoon lecture….that having someone standing by your side is good enough….


    See if you still agree after having several courses in vet school, or at least understand why so many others disagree.
     
  27. canis13

    canis13 Tufts V'15

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    Just wanted to say that I agree with minnerbelle and bunnity - helpers helping and experienced surgeons doing the surgery seems to be most effective in instances where you are trying to make a difference that leaves a lasting impact. i understand that people need to learn how to perform surgery, and everyone needs to have an animal that they first perform surgery on, but when you are in an already disadvantaged area, it does not make much sense to have that surgical learning take place there.

    one thing that i've found to be very rewarding has been my experience volunteering with RAVS (or as they are now known, HSVMA Field Services). i've now gone on two trips, and if anything, they didn't let me do enough; the most recent trip i went on, i spent way too much time on one day baby-sitting the ancient autoclave on the stove when i could've been learning and helping out with surgery prep and recovery. but their automatic autoclave broke, the surgeons needed sterile instruments to perform spays (they do 60+ a day), and someone needs to do the grunt work sometimes. so i felt like i helped, i learned about what is involved in working in a spay and neuter clinic on a reservation, i was able to connect with and talk with 30+ veterinary students about what it's like to be a vet student, and i was able to solidify my desire to become a veterinarian. (and the other days i was able to spend all my time in surgery prep and post-op recovery, and another pre-vet girl worked the autoclave.)

    i am fully confident that i will make a great veterinarian, and that i will be a great surgeon and i fully plan to make working/volunteering in a spay/neuter clinic a priority once i have my DVM. i know i like observing surgery, but i do not feel like i need to learn how to perform surgery now, as a pre-vet student. i also never really felt comfortable forking over $2000 to get veterinary experience. i was very much considering doing a VIDA or World Vets trip, and i know that i want to work internationally in my career as a public health veterinarian, but over the last couple of months i've realized that given where i am now, experience wise and money wise, i feel like the better ethical decision for myself is to stick with volunteering with groups that are in my own country.
     
  28. scb44f

    scb44f MIZ c/o 2015

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    I just want to clarify a few points.

    My point about knowledge of anatomy only meant that if you know anatomy, you can't automatically perform surgery (i.e. it takes experience as well), which goes back to my belief that if a vet is standing right by you guiding your every move, it can supplement a lesser knowledge of anatomy and physiology. Also, it's not like the vets can say only so many words, are blindfolded through half the surgery, and can't use their hands. They readily communicate with those at the table at all times in all sorts of ways.

    I stated early on in the discussion that the packet and the day of training didn't seem like enough. I'm not sure where you got the idea that any of us truly believed it was...

    To others commenting on TNR programs and the pace they go, I should note that I never saw anyone turned away because there were too many animals already, and we all stayed on-site until the last animal presented for surgery was done. This was never past 7 pm. Isn't it possible that the reason they offer multiple days each year is to keep up with the demand? I don't know if this is true, but it is also possible that they might add dates if they feel that there is a higher demand for their services. We also spent more time in communities with larger populations and in those that VIDA had been visiting longer (i.e. those with higher demand). In the end, we sterilized more animals in communities with higher demands.

    However, I do realize that licensed vets could have performed surgeries much more quickly than any of us. I'm definitely not arguing against that.

    About using zip ties for spays, they were obviously not used on cats or small dogs, but the technique was questioned during our first day there by one of the volunteers. The response we got was that a study (which I don't know any specifics on) has shown zip ties to produce no more complications than sutures. The zip ties are sterilized before use, and they are, of course, a polymeric material, just as suture is.

    Using trash bags isn't as bad as it sounds... They were situated on top of portable tables, since the smooth surface of the trash bags are easier to clean between surgeries than the rough surface of the tables they had.
     
  29. bunnity

    bunnity Penn 2014

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    Right, that's why vet school doesn't go anatomy --> surgery.
    More like anatomy + histo + biochem + physio + neuro + cardio + multiple surgery classes --> practice on dead animals --> surgery.
    Second years at Penn have an entire semester class on surgery where they learn everything BEFORE their live surgery class third year.

    It's kind of like how you can talk someone through landing a passenger plane but you don't do that just for experience or because someone gave you $2000.
     
  30. CorporateFatCat

    CorporateFatCat UC Davis c/o 2016

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    Highly-experienced vets can mistake a ureter for an uterine horn. I've seen it happen. As for pre-vets preforming an OVH on a stray dog, I would have to agree with it in the case that this is something that needs to be done as a public health issue. If there were enough licensed vets floating around 3rd world countries, then I'd say it's their job to do. This is obviously not the case. I encourage all of you vet students railing against VIDA's cause to donate your time as a DVM in a 3rd world country so under-qualified people don't have to. It's rather hypocritical to say "this is not your job" when no one else is taking it on.
     
  31. scb44f

    scb44f MIZ c/o 2015

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    Okay, I'm not arguing against knowledge serving as a foundation. I'm only saying that in the situation that VIDA creates, it is morally and ethically (morals = personal code, ethics = code of a group) acceptable for me to participate in surgery because there is a licensed vet watching your every move. This vet has both the knowledge and the experience which is why I'm comfortable with the situation. It would be a totally different story if I took what I "know" (which is nearly nothing since I don't have formal education in surgery) and tried it out on an animal unsupervised. Bottom line: it's up to how the individual feels about the situation. If you feel that it is morally or ethically wrong to participate, then you shouldn't do it.

    I'm sure we're giving those considering a VIDA trip a lot to think about :p I'm glad the discussion has come up and am happy there is a pretty wide variety of opinions on the topic. :thumbup:
     
  32. Trilt

    Trilt NCSU c/o 2016 Gold Donor

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    Nobody is handing a vet $2000 just to do surgery, and I dislike that people keep portraying it that way.* That is really not really an overly high or ridiculous cost if you look at a variety of similar international trips (both volunteer and tourism-based) that includes lodging, almost all food, activities, translators omnipresent, etc. Also, I'm pretty sure nobody says that they did this trip ONLY to help the communities in need down there, and that they're SO PASSIONATE about sterilizing animals in central america.... it is definitely a trip to experience a different culture, different environment, and a different type of medicine. A big plus for some is that you're working to reduce animal overpopulation.

    I personally would have no problem being put into a technician role in the upcoming VIDA trip I'm coordinating so, please scratch me off the $2000-for-surgery-time wide brush stroke. However, I don't believe that the surgeries and role they play is unethical for a variety of reasons, and most of these have been brought up already.

    My thoughts:
    Every person I have spoken to (and every individual on this forum thus far) has emphasized how closely observed and monitored they are during surgery, and I think that a lot of the complaints people are holding about inexperience should be allayed by this; there is a fully trained, competent veterinarian checking off on everything students do. I feel that some of the individuals who are arguing against the surgery are not being fair in their arguments in this regard- throwing complications left and right is demeaning to the trained veterinarians who are supervising. Students are required to observe surgeries before hand, so, to borrow someone else's terminology - it's not like they're thrown in with a scalpel and a prayer. Add this with the fact that there is very heavy supervision and I guess the end result is that you can do your own personal moral arithmetic. I personally don't see it as inhumane, and think that the trips do significantly more good than harm.

    Last thought:
    There is a difference in the level of veterinary care expected in each country. In Costa Rica, it's legal to have someone perform surgery under supervision, while in the US the veterinarians are the only ones legally allowed to. Different standards of care for different countries - who exactly should say which one is "right"?

    Real last thought:
    As I said in the other thread, I think anyone going on a trip should have this discussion (or at least read it). There is a significant chance that it could come up in interviews, and individuals should have a coherent idea of their opinions on the subject and be able to justify it for individuals who may disagree.

    *(I totally own up to going because of these sloths, though.)
     
    Last edited: 11.28.10
  33. 168135

    168135

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    I would also like to thank people for bringing up their different views. It's nice to get a different spin on things and I kind of wish this was discussed before my trip. It wouldn't have discouraged me about going, but it probably would have made me more aware of what I was about to embark in and what other people think. My profs, vets, friends and family were all for me going and it's kind of fresh to hear someone say "Hey, have you thought about this point and this point before you go?"

    I never dreamed of ever stepping foot in Costa Rica or Nicaragua. If someone had handed me a thousand dollars and told me to go wherever I wanted, I would have never chosen to visit Costa Rica... and Nicaragua is out of the question because I had never even heard of it prior to the trip :p (I would have heard about it in September though... Survivor Nicaragua!). It was incredibly eye-opening. I would have never thought that a North American country had so much poverty. I have heard that Mexico is pretty bad off, but I've never been there, ya know?

    It was also quite interesting to see how different the practice of veterinary medicine is. All of the vets down there were a lot more compassionate than some that I have worked with :rolleyes: Same with the volunteers. Our group was AWESOME. It was refreshing to be around people who are as passionate and hardworking as I am. If SDN arranges another trip, I'm sure the members will be just like that.

    It's like 5am... I should probably get some sleep. Finally finished my essay on Hinduism... I reeeaaallly want to travel to India now :p
     
  34. Nexx

    Nexx 2 weeks and counting

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    At the risk of sounding hypocritical since I am going on a rural trip in just over a month there are some inherent pitfalls and issues that I can see coming up.

    I can't speak for VIDA or any other organisation but simply having a vet sign off on a form that you have observed 25 hours of surgery is a bit slack on the checks and balances portion. I've been a nurse/tech (OTJ trained) since 1996 and have seen countless hours of surgeries. How many of those hours was I actively paying attention to what was going on in the gaping hole in the dog? Can't say for sure, early on in my career I know I probably day dreamed a bit too much or was panicking focusing on every blip blip bloop of the anaesthetic machine. How many people for their 25 hours didn't get up close and personal to see what was going on? vetsbeyondborders over here in australia has what I would call an EXHAUSTIVE application process. They asked for 2 references and sent them a short questionaire about how my clinical skills were and then had me answer a several page sheet on how to calculate dehydration %, IV fluid rates, what iv fluids to use, and vital monitoring for a dehydrated puppy. They asked my surgical scrub technique, they asked my thoughts on euthanasia, and thoughts on field protocols. Took me a good 45-min to an hour to write everything up thoroughly and adequately -- and that was just to volunteer with them as a nurse!!!!! not a vet student or vet!

    As people have said there is a lot to learn about anatomy, sterile technique, tissue handling, and suturing that takes a bit longer to learn than just 25 hours of watching someone else do the surgery. I realise that these trips have supervision, but as it has been mentioned a single vet can probably do the work of 2 vet students, if not more! Heck it is still taking us about anywhere from 1 hour to 2 hours to do a 'routine' spay as students.

    Now I say all this with the risk of sounding hypocritical as I prepare to go on my own rural trip to India in about a month. Again this is as a 4th year student who has had the education and performed surgeries already at university. I'm a bit worried that we are going to be left on our own more than I would like.

    Not all trips may be the same, but I think the question is really to what extent should students be seeking out opportunities to perform advanced medicine skills for which they may not have the requisite background to perform? While it may be legal in another country for you to perform acts of veterinary medicine, that doesn't make it morally or ethically in the right -- just legal.

    http://www.avma.org/issues/policy/ethics.asp

    I don't think that perhaps all people who have gone on these trips have been 'unethical' but I feel there is a MUCH higher potential for poor care, poor surgical practice and therefore unethical behavour for unskilled/semi-skilled persons performing surgery under what may be dubious circumstance.
     
  35. sunshinevet

    sunshinevet

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    See, I find this unethical. It's not like the people who go on these trips are staying in these countries, recieving certification to continue to competantly spey and neuter and doing the whole thing full time. It's not like they're vet students learning to do surgery because very very soon they'll be out in the real world doing it. Instead, it could be any layperson/tourist who got 25 hours in a vet clinic, going to "learn" how to perform surgery! And I personally feel that best practice should ALWAYS be deferred to - where possible, use it - and in this case, it seems unethical to me that there is a competent, capable, experienced surgeon standing there watching a layperson cut in. Best practice would be the other way around, and it would be in the animals best interests for it to be the other way around. I've no problems with these people teching. But if there is someone there who has the experience, has the knowledge, has the tissue handling finesse, and thats not being utilized so a layperson can perform surgery on an animal, to me that is unethical.

    Obviously I understand that many people who go on these trips are prevets wanting to go to vet school. But IMHO, that is what vet school is for!!!

    And obviously, a surgeon standing there teaching a vet student is a different beast - it is out of nessecity. There is no nessecity for prevets to be performing surgery on these trips.
     
  36. 168135

    168135

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    But a surgeon isn't just standing there, watching someone cut into a patient. I think we all made that clear. Like TT said, we were like puppets on a string. At no point was their hands out of the patient :rolleyes:
     
  37. alliecat44

    alliecat44 KSU CVM Class of '11 Moderator Emeritus

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    I think you're missing the point...
     
  38. nyanko

    nyanko all i do is win Gold Donor

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    Then why were you even necessary?

    edit: If there really was one vet supervising each pre-vet for each surgery they did, then still nobody has addressed the point that many people have made: why don't the vets just do the surgeries themselves?
     
  39. twelvetigers

    twelvetigers Throw the ball throw the ball THROW THE BALL Gold Donor

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    Yes, yes, this is a great point to make. Is the standard of care in the U.S. necessarily what everything should be measured against? Is the way that they do things 'wrong' just because it is different from how *we* do it?

    There's another thread in the forum now that discusses the moral implications of procedures like declaws, tail docks, and debarking surgeries... this alone should illustrate just how different things are for vets here.

    I think it's a fallacy to look down on another country's standards of practice just because they are different.
     
  40. 168135

    168135

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    I have a few questions reguarding the NAVLE (is that correct?).

    We did have a veterinary graduate on the trip with us. She graduated from a non-AVMA accredited university. She was originally living in the states and had to pass her NAVLE to become a vet. She did not pass her spay because she took too long to complete them. She was working at a hospital as a tech but I guess she was not allowed to practice her spays there. The reason why she came on the trip was so she could improve on that and pass her exam.

    Vets in that situation... are they allowed to perform surgery in North America under veterinary supervision or are they forced to go back to school or go to another country in order to practice?

    Just curious. It's possible that the hospital chain just doesn't allow students to train under a licensed vet. I didn't ask. I'm just wondering how often situations like that arise. I'm thinking it's cheaper and less time consuming to practice during one of these trips than to get into a class at a veterinary college. Maybe that's not how it works, I donno.
     
  41. turquoisewolves

    turquoisewolves c/o 2015

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    Playing devil's advocate.....
    Could it be possible that thats not entirely the point of these organizations' mission?
    I see where the vet students are coming from.....they are thinking pre-vets are "playing" vet without any knowledge of what they are doing, which can be offensive to the honor of a DVM.
    Granted, they don't have the knowledge (pretty sure the vets in charge are aware of this)
    ....but I'm beginning to see it from the perspective that these people aren't doing it to "play" vet. It's just a new experience gained in the world of veterinary medicine more from the perspective of a veterinarians eyes....in a sense being a robot (as in telecommuting surgeries that MDs are beginning to use with actual machines) to the actual surgeon. It doesn't look like to me that the people in charge expect any of these participants to be as knowledgable as a veterinarian because its not necessary to the experience they are offering (does that make sense...sometimes I dont word things correctly)

    And TT I really like your statement!
     
  42. scb44f

    scb44f MIZ c/o 2015

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    Like I said, ethics are the code of a group. If VIDA is doing this, with people who are informed of what is going on (they can literally watch us doing surgery, though not close up), I don't consider it to be unethical. Yes, it would be unethical here in the States, and in other places, but that's because it is widely unaccepted (i.e. it is unaccepted by a group of people), and, on top of that, it is illegal. If you still want to apply your veterinary code to a community who has different values and feelings about animals, then fine, that's your choice, but the perspectives there are much different from the perspectives here, as is the code of ethics (not that it's much different, but there are differences... don't want to make it sound like things are not the same at all in the two places because there are obvious similarities).
     
  43. that redhead

    that redhead MMXV

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    I'm not really sure where I stand on the issue. The first thing that crosses my mind is that I wouldn't pay $2000 (or whatever the trips cost) to travel to another country and cut open a dog when there are so many veterinary hospitals/shelters/clinics across the country that would gladly accept another pair of hands.

    As a technician at a small animal clinic, I scrubbed in to probably four or five surgeries: spays, neuters, exploratories, gastrointestinal operations. I was always responsible for monitoring anesthesia, since I was in there to get a look at everything anyway, but sometimes got to scrub in an hold an instrument or work cautery or something similar. I guess for me, performing a surgery without the thorough, supervised, continous training offered in veterinary school itself would scare the **** out of me. Taking another life in my hands (to provide a good service or not) is not something I would take lightly. I understand that a veterinarian is supervising the volunteers on these trips, which is better than nothing, but it really begs the question: why can't they do the surgeries and have the volunteers scrub in? To me, this makes the situation seem even more as though one is paying to operate on animals in another country where it IS legal (versus the US or Canada, where it is not).

    Although I can certainly understand the arguments made by those who have experienced this trip first hand, I ultimately don't think it's an ethical practice. If one were able to operate with the speed, efficiency and safety of a seasoned veterinarian, I don't have a problem. But we all know that prolonged anesthesia isn't in the best interest of the animal, not to mention the other potential pitfalls that lurk just about everywhere when it comes to surgery. Also, the whole think just reeks of paying to operate and gain this "one up" experience, which kind of negates the positive mission of the organization in the first place, in my mind.
     
  44. bunnity

    bunnity Penn 2014

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    I think regardless of the ethics, this question keeps coming up:

    Why would you choose to have unexperienced hands doing surgery that experienced, licensed, educated hands could do better, safer, and faster?

    I haven't heard a good answer to this yet. It's necessary in vet school in order to become a vet (and where there is a lot better equipment and monitoring in case something does go wrong) but I can't think of a good reason outside of vet school - and it seems like no one else can either.
     
  45. StartingoverVet

    StartingoverVet Flight Instructor for hire Gold Donor

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    $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
    or lack thereof.
     
  46. squeegee

    squeegee

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    but it has already been mentioned countless times that the vets are there, watching every move, hand over hand, etc. so the money (or lack thereof) already got them there. they are physically there and obviously capable. so why use the volunteers as middlemen if it's been established that veterinarians can probably perform the surgeries more knowledgeably and efficiently, if not for volunteers to be able to say they performed the surgery?

    i might also take this opportunity to mention a former colleague of mine (current 3rd year) went on one of these trips last summer with her mother. her mom has never observed any kind of surgery and knows next to nothing about veterinary medicine and was still offered the opportunity to participate in a surgery (she declined)
     
  47. squeegee

    squeegee

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    how did this work? did you have to make surgical incisions for each tie, since they don't have a cutting edge like suture material does? how were you able to keep an incision closed as tightly and edge-to-edge as suture for adequate healing, since zip ties can only tighten so far? and did they have arrangements with the owners to come back to have the zip ties "removed" since they're not dissolveable like suture material? sorry i'm not trying to be all "geez wtf horrible idea" or anything, i'm just genuinely curious :)
     
  48. Nexx

    Nexx 2 weeks and counting

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    Wow, that's being a bit morally ambiguous about things. To put this in perspective that's akin to me saying I'm going to head to africa and start circumcising women because that is socially acceptable there.

    Really your moral compass changes based on your geographic location? Are you planning on practicing in the US when you are done? (Or any other 1st world nation for that matter?) Because if you note this practice is not allowed in Canada, US, Australia, UK and host of other nations I am sure. The thing is there is potential to cause harm and whether or not it happened on your watch is not the point. Simply the fact that and can (and probably does) happen. As vets and pre-vets were are meant to reduce suffering and use our knowledge to further the profession and it can be (and is being) argued that these trips diminish that.

    I'd encourage a quick read of from here: http://www.avma.org/issues/policy/ethics.asp with specific attention paid to the professional behaviour section. These are some of the 'core' ethics as put forth by the AVMA and I think that these trips for pre-vets may not quite fall in line.


    Overall I think this all stems from an interest to gain interesting experience and have that divergent experience to 'stand out' amongst peers. Sure it is fun and puts the drive for you to succeed perhaps at the pre-vet level but in the end it doesn't mean a thing to anything beyond anyone but yourself. I can probably guarantee that you will look back on it in a few years and think "My god I can't believe that animal lived" -- been there and done that myself!

    The thing that annoyed me to no end working as a full time tech and full time prevet student in a vet school town was all of the fighting and clamoring for more experience, more technical procedures, more this and more that between people I worked with. In the end vet school doesn't really care! They like to see your references, they like your GPA, your GRE, your devotion to the field (# of hours), they like to see you as a person. Above and beyond that they don't look at too much else and they plan on teaching you a lot of the basis for your technical competencies.

    In the end, save your $2000 for when you can really help out by buying a plane ticket to some remote part of the world once you have some more education. Until then it is possible that more harm may come to an animal--which is the REAl ethical dilemma. I don't think any of us want that, that much I definitely know.
     
  49. Nexx

    Nexx 2 weeks and counting

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    Sounds like they might be using the zip ties to ligate the ovarian pedicles/uterus. Not for closing ;)
     
  50. squeegee

    squeegee

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    ahhh gotcha. i guess i automatically associate suture with incision closing :p still i feel like i would be worried about not being able to get those ties tight enough, especially around the uterus...i suppose that's where the dog size came into play though!
     

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