Surgical Skills

[thnythe]

How and when do your schools teach surgical skills?

Do you feel like this is an effective way of teaching?

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[alliecat44]

We have small animal surgery in the fall semester of our junior year. You get one 2-3 hour surgical techniques lab, where your group rotates through different stations. However, only two of these are actual surgical skills--one station for suture patterns and one for hand-ties. The rest are for scrubbing, gowning/gloving, draping in. Other than that, we have how-to videos posted on our school website. We practice suturing on muslin cloth at home on our own time and then perform surgery on shelter dogs.

What bugs me the most is that we don't get evaluated for patient care in the junior surgery course. So even though your group is responsible for the patient all week, people can totally slack, write ridiculous things in the medicial record, etc and there's no repercussion. One guy I know left our patient with a fever and a cough overnight. I came in to discharge the dog in the morning and her temp was over 104.1. He was too lazy to page the resident--but no repercussions because nobody's monitoring patient care that closely. We're supposed to police each other.

Sigh.

 

[sofficat]

We have small animal surgery in the fall semester of our junior year. You get one 2-3 hour surgical techniques lab, where your group rotates through different stations. However, only two of these are actual surgical skills--one station for suture patterns and one for hand-ties. The rest are for scrubbing, gowning/gloving, draping in. Other than that, we have how-to videos posted on our school website. We practice suturing on muslin cloth at home on our own time and then perform surgery on shelter dogs.

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That doesn't seem like a lot of surgery time. Do you only do spays and neuters on the shelter dogs? What about other surgical techniques? I won't go into detail (thanks peta) but we get a lot of surgery time (soft tissue, ortho stuff, CCL repairs etc), including spaying/neutering shelter dogs. This year they even added a large animal portion. And we definitely get evaluated for patient care (professor has to check the patient the next morning with us, ask us temp and how our patient is etc).

 

[laurafinn]

We have 20 small animal surgery lectures in third year, then have 35 lectures fourth year. Fourth year we have 8 4-hour labs; 4 labs of these are surgery on live animals (ex-laps, gastrotomies, embryo transfers, spays), others are cadaver surgery (enterotomies, vasectomies, gastropexies, tenorrhaphies, extracapsular cruciate repairs). We are in groups of 3 for these, so someone is the surgeon, another student is the surgical assistant, and another is on anesthesia. We also do enucleations on cow cadavers. Fifth year we have the opportunity to do more surgery on rotations and during externships. I'm three weeks into fifth year and now am a confident cat neuterer -- everything else is still a little intimidating! But I still have at least 3 solo spays to do during rotations, plus whatever else comes in.

 

[Angelo84]

We learn instrument and hand ties, and suture patterns in a two or three hour lab on pig's feet in spring of second year. In the fall of third year we are tested on hand ties, instrument ties, instrument id and soaping. We then do two dog spays in pairs of two one on anesthesia one surgeon. We have an intern and a resident handy to help if need be and we are checked at various points (ligations, checking stumps). We were responsible for practicing ligatures and suturing on our own and had some videos to watch to go over the actual procedure.

I think overall the training was sufficient to allow me to feel okay about doing the two spays. However I don't think that the two spays are sufficient surgical experience to graduate with and am using my elective time during clinics to get further surgical experience. We do have a core surgery rotation during clinics but since many of the surgeries are specialty sugeries we do a lot of retracting and closing. Any spays/neuters that come in during our surgical rotation are ours to do.

 

[SOLDIER]

Poor animals

 

[Truth74]

I think Illinois' class of 2013 will be more confident when our turn at junior surgery comes along. During clinical rotations the first 8 weeks of first year, we went to the clinical skills lab where we were given instructions specific to the rotation. We also got hands on instruction or demonstration with patients going through the teaching hospital.
I learned:
aseptic technique, instrument identification, gowning, suture tying (instrument and hand tying), intubation, record keeping, patient monitoring during induction, procedure, and recovery.
And that was just one of the eight rotations. I look forward to next October, when we do it again.

If it goes as planned, we'll start junior surgery in mid-fall of our third year. I'm hoping that all of this extra practice and instruction will help.

 

[sumstorm]

We had intro to surgical instruments and suturing during first year orientation. we start surgery during second year fall semester. many of us perform surgeries first year first semester during electives/selectives/wetlabs/special opportunities.

 

[mtrl1]

At Davis, everything mostly happens during 3rd year. We have our core surgery lecture course fall, with ortho sx and soft tissue elective surgery lectures spring of 3rd year.

The sx lab runs all of third year; we have gowning/gloving/draping, suturing on pigs feet, and 3 cadaver anatomy labs in which we do a spay and neuter on cadavers for the last one. We start surgery on live animals mid-Fall and the course runs through spring. We're in groups of 3 and everyone does one dog castration, one cat OVH and one dog OVH with the other two team members alternating as assistant surgeon and anesthetist. All of the animals come from neighboring shelters and are put up for adoption if they have not already been adopted.

We had one ophthalmology surgery lab where we did 5 procedures on a cadaver head, including an enucleation.

During our senior year, we have a community surgery rotation where we perform other surgeries, both spays and neuters as well as other procedures for Mercer clients (our clinic for the pets of the homeless in Sacramento) and VMTH clients who may not be able to afford the full VMTH cost of the procedure. Supposedly it's quite varied with mass removals, enucleations, ex-laps, amputations, splenectomies, C-sections, cystotomies and whatever else presents itself. All the seniors I've talked to rave about how great the rotation is...they've recently changed our schedule so now we have 4 weeks of community sx.

 

[K9VET]

All schools have different methods (bad and good ones). How good your skills get depends on two factors: (1) your innate talent for surgery and (2) how much you study, assist other surgeons and PRACTICE. Regarding the first one, there is nothing you can do about it. I have seen vet students with amazing sx skills. This is similar to the talent some people have to play piano by ear, for instance. However, if you are not very good at piano playing you can become very good by practing, practicing and practing. Your motivation will get you there! You need to find out what things hinder you from becoming a good surgeon: poor anatomy background? Fear/confidence? Hand ability/skills? Once you know what areas you need to improve - attack them!

If you think you want to become a surgeon, do lots of externships assisting other surgeons. They will help you develop your skills too. Find someone who likes mentoring. Be a motivated vet student/intern/extern.

Be passionate about what you like and go for it!

 

[Electrophile]

This is one of the areas I think Mizzou does a really good job. Because we're 2+2, our soft tissue surgery lectures are in the second half of spring semester of second year and ortho lectures and third year surgery lab is during the summer between second and third year because we go during the summer. So we get it a little sooner than just about everybody else. We do 3 live surgeries (mostly celiotomy kinda stuff, plus 2 spays and a neuter) and 3 cadaver surgeries (leg amputation, lateral suture CCL repair, placing an external fixator). We also use the cadavers from the live lab to do common clinical procedures, like placing a urinary catheter in a female dog and trying an epidural. The one thing that did kinda annoy me was during the clinical procedures lab, some interns came over and kinda hogged the stations.

Anyways, surgery lab was highly stressful (for me at least) so I didn't take the elective surgery lab the last instructional block in classes before switching to clinics, but doing the live surgeries has helped when I was on call during my ortho elective rotation a few weeks ago. And I neutered my first two cats (with a laser too!) on my preceptorship last week. Also spayed a puppy last week too, but the suspensory ligament on one side was so fragile, I broke the ovarian vessels too. I promise I didn't mean to break it that hard! Fortunately, the doctor found the end and ligated it no problem and it hardly bled at all. WHEW! However, I did finally learn the dreaded Miller's knot for an instrument tie and it's not quite so bad.

 

[RazorDoc2010]

To add to Electrophile, I took the elective surgery course at Mizzou in my third year and we did the following procedures:

Orthopedic Surgery: Midfemoral amputation, Femoral Head & Neck, Juvenile Pubic Symphysiodesis

Ophthalmic Sugery: tarsorraphy, wedge biopsy of eyelids, entropion/ectropion procedures, and enucleation

Mandibular Surgery: fixing symphyseal fractures in cats, lateral mandibular fractures in dogs, different wiring techniques, etc.

Soft Tissue: splenectomy (using vascular clips, an LDS stapler, and a LigaSure), intestinal resection and anastamosis, partial gastrectomy, and lots of others

Emergency Procedures: repair of a prepubic tendon rupture and a couple other things that I can't remember

We get a lot of really good surgical experience even prior to clinics!

 

[Electrophile]

Somebody told me you guys got to do a TightRope CCL repair...is that true? If so...JEALOUS!

 

[alliecat44]

Wow, super impressed and jealous. We get to do two sterilization procedures--one spay and one neuter, or two spays, or (for the unlucky few) two neuters. That's it in the classroom/surgery lab until soft tissue surgery, which I've heard is one or two more spays/neuters and that's pretty much it. (Haven't gotten there yet, though, obviously.)

If I may ask, how are your animals for these labs sourced? Are they live surgeries or cadaver surgeries?

 

[StealthDog]

We do three spay/neuter labs during second year and work in groups of three students, so each of us does one surgery, then is an assistant or runs anesthesia for the other two labs. Third year there is an elective GI terminal surgery lab, where we again work in groups of three and divide up who does a gastrotomy, intestinal resection/anastamosis, or cystotomy. We also have an orthopedic surgery elective where we learned to place plates and IM pins in Sawbones models and in a cadaver leg. Fourth year, we have an elective small animal surgery rotation where we spend two weeks doing spays and neuters on animals from rescues- we each end up doing six to eight procedures. I also took a shelter medicine externship where I did spays and neuters all day for two weeks- by the time I was done, I was doing 8 to 12 surgeries a day. That's definitely the experience where I've grown most as a surgeon... I highly recommend looking for a high-volume spay/neuter externship with a good mentor!

 

[RazorDoc2010]

Somebody told me you guys got to do a TightRope CCL repair...is that true? If so...JEALOUS!

No, the only time we did a CCL repair was in the first surgery class (unless someone just asked if they could do it on their own with Dr. Cook/Fox), and that was just the standard extracapsular repair. Our ortho lab was the midfemoral amputation and the FHNE....I wish we could have done a tightrope though!

 

[RazorDoc2010]

If I may ask, how are your animals for these labs sourced? Are they live surgeries or cadaver surgeries?

Both live and cadaver. In our first surgery class, they supply 3 dogs for each group from a Class A dealer (correct me if I'm wrong electrophile). We would alternate doing a live surgery and a cadaver surgery. In our advanced elective, we were mainly using cadavers supplied by the animal shelter, although we did have one live animal lab (the laparotomy procedures).

 

[Electrophile]

alliecat, yeah, ours come from class A (aka: purpose bred) dealers.

 

[cyclone]

At Iowa State we take surgery lecture and lab both semesters 2nd year. This entails cadaver surgery but mostly general suturing, instruments and sterile technique. Fall of third year we perform all live surgeries every week. This includes spays, neuters, abdominal exploratories, nephrectomy, etc. The Second semester of third year small animal soft tissue and orthopedic surgery electives and equine surgery elective are offered. 4th year involves many surgery rotations too, where you perform the procedures. From most graduates of Iowa State that I have talked too, they feel very confident in their surgical skills when they graduate and are comfortable performing most procedures on their own.

 

[HarryTheVet]

We have 20 small animal surgery lectures in third year, then have 35 lectures fourth year. Fourth year we have 8 4-hour labs; 4 labs of these are surgery on live animals (ex-laps, gastrotomies, embryo transfers, spays), others are cadaver surgery (enterotomies, vasectomies, gastropexies, tenorrhaphies, extracapsular cruciate repairs). We are in groups of 3 for these, so someone is the surgeon, another student is the surgical assistant, and another is on anesthesia. We also do enucleations on cow cadavers. Fifth year we have the opportunity to do more surgery on rotations and during externships. I'm three weeks into fifth year and now am a confident cat neuterer -- everything else is still a little intimidating! But I still have at least 3 solo spays to do during rotations, plus whatever else comes in. I like the way Massey prepares its students to do surgery and feel like I will be a confident soft-tissue surgeon when I graduate.

I have to disagree. I think Massey SUCKS. The vets I have been working for say Massey graduates are way underprepared for practice. I have learned far more spending summers working at decent practices than I ever learn at the stinking turd-pool that is Massey. They should stop teaching us how to grow stinking grass, and other cow crap, and teach us the veterinary medicine we're paying $44k a year for.

 

[BlacKAT33]

I have to disagree. I think Massey SUCKS. The vets I have been working for say Massey graduates are way underprepared for practice. I have learned far more spending summers working at decent practices than I ever learn at the stinking turd-pool that is Massey. They should stop teaching us how to grow stinking grass, and other cow crap, and teach us the veterinary medicine we're paying $44k a year for.

I realize you are upset about many things at your school. I am beginning to wonder if you are a real student or a troll (since you just joined this Jan and have been bashing Massey since). I have never heard someone express so much hatred towards their school before. If you are going to do it, I would prefer a more professional post. Please work out the problems with your school...AT your school, instead of posting hate messages everywhere.

 

[HarryTheVet]

I realize you are upset about many things at your school. I am beginning to wonder if you are a real student or a troll (since you just joined this Jan and have been bashing Massey since). I have never heard someone express so much hatred towards their school before. If you are going to do it, I would prefer a more professional post. Please work out the problems with your school...AT your school, instead of posting hate messages everywhere.

Wrap up, will you? We HAVE been trying, believe me. Heaps of Americans and a few Asians have transferred home or dropped out because they saw the writing on the wall. I made the mistake of believing what I was told, so am now stuck here. You're probably right that most schools have aspects that annoy their students, but Massey is just spectacularly bad. On the plus side, it does have some outstanding lecturers. And the CALVE website is pretty useful. And we do have a CT scanner now, which is pretty sweet. And now we have a digital xray (there are only a couple in NZ). But that's about it.

Seriously, I'm not one to whinge at all. Generally, I am a cup-half-full kinda person. So for me to be so vitriolic about the place, they must be really, really bad.

 

[LVT2DVM]

for the schools that offer surgery electives (ie SA or LA advance surgical techniques) are those classes limited in the number of student that can attend? How does your school handle students that are "mixed-animals emphasis" for those classes that are limited.

We have a large number of "mixed-animal" students in 2013 (and 2014) despite NO change in the max number of students allowed in elective surgery courses (~30 spots for a class of 102), on top of "mixed" emphasis loosing in priority over small or large tracking students for those courses.

concerned and wondering about alternatives--