Humane teaching methods within veterinary and other biomedical

education

ANDREW KNIGHT ANDREW KNIGHT

DipECAWBM (WSEL), PhD, MRCVS, FOCAEDipECAWBM (WSEL), PhD, MRCVS, FOCAE

First year cell biology labFirst year cell biology lab

““What you’ve seen so far is only the tip of the What you’ve seen so far is only the tip of the iceberg compared to what you will have to do iceberg compared to what you will have to do to animals later in the veterinary course.to animals later in the veterinary course.

Perhaps you should re-think your choice of Perhaps you should re-think your choice of career…” career…”

Humane teaching methodsHumane teaching methods

• high quality videos/computer simulations• ‘ethically-sourced cadavers’ • preserved specimens• non-invasive self-experimentation • clinical/surgical skills models and simulators• supervised clinical/surgical experiences

Computer simulations: dissectionsComputer simulations: dissections

www.cvmbs.colostate.edu/vetneuro/VCA3/vca.html

‘Face’

- Prodissector

www.DigitalFrog.com

Ethically-sourced cadaversEthically-sourced cadavers

Canine vascular cast of the liver/gall bladder

Canine tracheobroncheal cast

Computer simulations:Computer simulations: experimentsexperiments

ModelsModels

Clinical skills training mannequinsClinical skills training mannequins

‘‘Alternative’ Alternative’ veterinary surgical trainingveterinary surgical training

1. Knot-tying boards, plastic organs and similar models: basic manual skills such as suturing and instrument handling

2. Ethically-sourced cadavers: simulated surgery

3. Real patients: observing, assisting with, and then performing beneficial surgery under close supervision (e.g. shelter animal neutering programs)

Surgical simulators: DASIESurgical simulators: DASIE

Surgical simulatorsSurgical simulators

Alternative surgical trainingAlternative surgical training

Alternative Veterinary Surgical Alternative Veterinary Surgical Program, 2000Program, 2000

External clinical experience in private clinics or animal External clinical experience in private clinics or animal shelters assisting with or participating in surgery and shelters assisting with or participating in surgery and anaesthesia. anaesthesia.

Sterilisations of real patients, e.g., from animal Sterilisations of real patients, e.g., from animal shelters, at Murdoch.shelters, at Murdoch.

Attendance at all of the terminal surgical laboratories Attendance at all of the terminal surgical laboratories as observers. as observers.

Simulated abdominal surgeries on a “DASIE” (Dog Simulated abdominal surgeries on a “DASIE” (Dog Abdominal Surrogate for Instructional Exercises).Abdominal Surrogate for Instructional Exercises).

Ethically-sourced cadaver surgery: abdominal and Ethically-sourced cadaver surgery: abdominal and orthopaedic surgeries.orthopaedic surgeries.

Outcomes:Outcomes:

Did not participate as surgeon or assistant surgeon in a Did not participate as surgeon or assistant surgeon in a total of total of at mostat most 1313 scheduled surgeries scheduled surgeries

But… performed or assisted with a total of But… performed or assisted with a total of at least at least 6262 additional surgeries additional surgeries ((not including the abdominal surgeries I not including the abdominal surgeries I performed on a “DASIE” surgical simulator). performed on a “DASIE” surgical simulator).

Surgeries performed under supervision, mostly in private Surgeries performed under supervision, mostly in private practice. practice.

DepthDepth:: Jointly we sterilised 45 dogs and cats, including Jointly we sterilised 45 dogs and cats, including 21 spays.21 spays.

BreadthBreadth:: We also participated in a range of other We also participated in a range of other surgeries as well, e.g., umbilical hernia repair, cruciate surgeries as well, e.g., umbilical hernia repair, cruciate ligament repair, cutaneous polyp and lump excisions, ligament repair, cutaneous polyp and lump excisions, aural haematoma excision, abdominal surgeries aural haematoma excision, abdominal surgeries (exploratory laparotomy, enterotomy, enterectomy, (exploratory laparotomy, enterotomy, enterectomy, partial splenectomy, spay), orthopaedic surgeries partial splenectomy, spay), orthopaedic surgeries (trochanteric osteotomy, stifle arthrotomy). (trochanteric osteotomy, stifle arthrotomy).

Similar depth and breadth of anaesthetic experience.Similar depth and breadth of anaesthetic experience.

Effectiveness of humane teaching methodsEffectiveness of humane teaching methods

www.HumaneLearning.info, ‘Published papers, Comparative.’

ResultsResults

1212 papers published from 1989 to 2006 describedpapers published from 1989 to 2006 described 11 11 distinct studies of veterinary studentsdistinct studies of veterinary students::

9 assessed surgical training — historically the 9 assessed surgical training — historically the discipline involving greatest harmful animal use. discipline involving greatest harmful animal use.

Humane method:Humane method:

SuperiorSuperior EquivalentEquivalent InferiorInferior

45.5% (5/11)45.5% (5/11) 45.5% (5/11)45.5% (5/11) 9.1% (1/11)9.1% (1/11)

Surgical skills assessedSurgical skills assessed

psychomotor (all) ligation (Griffon et al. 2000, Olsen et al. 1996) intestinal anastomoses and celiotomy closures

(Carpenter et al., 1991) gastrotomy closures (Smeak et al., 1994) ovariohysterectomies (Griffon et al., 2000)

Superior learning outcome: Superior learning outcome: fluid hemostasis model fluid hemostasis model

At least as effective as a live dog splenectomy for teaching blood vessel ligation and division.

students completed their ligatures more quickly fewer errors their ligatures were tighter superior instrument grip

Students' initial scepticism regarding the use of alternatives for learning these surgical skills was dramatically altered. (Olsen et al., 1996)

Equivalent learning outcomesEquivalent learning outcomes

5 studies demonstrated equivalent learning outcomes using humane alternatives:

Carpenter et al. (1991) and Bauer et al. (1992) demonstrated equivalent surgical skill acquisition using cadavers as the humane option.

Greenfield et al. (1994, 1995) demonstrated a similar result using soft tissue organ models.

White et al. (1992) found that veterinary students from an alternative surgical laboratory program had surgical skills equivalent to those with a standard laboratory experience, after some initial hesitancy of the alternative students during their first live animal surgery.

Inferior learning outcome: Inferior learning outcome: gastrotomy hollow organ model gastrotomy hollow organ model

Two groups of 20 veterinary students:

one group practiced using a hollow organ model the other practiced using a live animal

Live animal gastrotomy skills later assessed (in subsequent laboratories)

No significant difference in overall gastrotomy closure technique

the students performing the procedure for a second time on a live animal were significantly quicker

However, the plastic model used was deficient, being more fragile and stiff than living gastric tissue, with suture pull-through occurring despite appropriate technique and tension (Smeak et al., 1994).

Short and long-term Short and long-term learning outcomeslearning outcomes

Most studies examined short-term learning outcomes

Pavletic et al. (1994) used employer questionnaires at the time of hiring and one year later to compare the skills of 12 new graduates from the Tufts University veterinary class of 1990, who had participated in an alternative small animal medical and surgical procedures course, with the skills of 36 of their conventionally-trained counterparts

No significant difference in:

Abilities to perform common surgical, medical and diagnostic procedures

attitudes towards performing orthopedic or soft tissue surgery

confidence in performing the listed procedures

ability to perform them unassisted

Non-surgical disciplinesNon-surgical disciplines

Cardiovascular physiology more efficient learning using interactive videodisc simulations (Fawver et al., 1990).

Microbiology more active learning with greater autonomy, using interactive databases containing digital images, movies and sounds (Whithear et al., 1994).

Bovine rectal palpation learnt more effectively using a haptic (virtual reality-based) teaching tool (Baillie et al., 2005a, 2005b).

Equine nasogastric intubation learnt more effectively (superior knowledge, practical skill and confidence) using a CD-ROM (Abutarbush et al. 2006).

Related non-veterinary facultiesRelated non-veterinary faculties

14 studies: undergraduate biology, medical, nursing, pharmacology, physiology and psychology students

Humane method:Humane method:

SuperiorSuperior EquivalentEquivalent InferiorInferior

35.7% (5/14)35.7% (5/14) 57.1% (8/14)57.1% (8/14) 7.1% (1/14)7.1% (1/14)

Comparative studies Comparative studies of student performance: all disciplinesof student performance: all disciplines

www.HumaneLearning.info, ‘Published papers, comparative.’

At least 33 papers sourced from the biomedical and At least 33 papers sourced from the biomedical and educational literature, covering all educational levels and educational literature, covering all educational levels and disciplines, describe studies that have compared the ability disciplines, describe studies that have compared the ability of humane alternatives to impart knowledge or clinical or of humane alternatives to impart knowledge or clinical or surgical skills surgical skills

Humane method:Humane method:

SuperiorSuperior EquivalentEquivalent InferiorInferior

39.4% (13/33) 39.4% (13/33) 51.5% (17/33) 51.5% (17/33) 9.1% (3/33) 9.1% (3/33)

Impact of chronology Impact of chronology on comparative studies on comparative studies

Of the 11 distinct studies comparing veterinary Of the 11 distinct studies comparing veterinary student learning outcomes, eight were more than a student learning outcomes, eight were more than a decade old at the time of review (published prior to decade old at the time of review (published prior to 1996) 1996)

Of the 21 papers describing non-veterinary student Of the 21 papers describing non-veterinary student learning outcomes, 18 were more than a decade old learning outcomes, 18 were more than a decade old

29 studies of veterinary students 29 studies of veterinary students notnot involving comparisons involving comparisons with harmful animal usewith harmful animal use

Additional advantages Additional advantages of humane alternativesof humane alternatives

time and cost savingstime and cost savings repeatability & repeatability & flexibility of useflexibility of use

savings of substantial numbers of animal livessavings of substantial numbers of animal lives increased compliance with legislative and Code of Practice increased compliance with legislative and Code of Practice

requirements about using alternatives to animalsrequirements about using alternatives to animals

decreased student exposure to toxic chemicals used to decreased student exposure to toxic chemicals used to preserve dissection specimens, with consequent risks of preserve dissection specimens, with consequent risks of adverse health effects and potential liabilityadverse health effects and potential liability

decreased potential for conflict with students unwilling to harm decreased potential for conflict with students unwilling to harm animals during their educationanimals during their education

Key advantages Key advantages

Ethical ConsiderationsEthical Considerations

Numbers of animals used: Numbers of animals used: Close to six millionClose to six million vertebrates dissected annually in U.S. high schools alonevertebrates dissected annually in U.S. high schools alone

Sources:Sources: Biological supply companies, Class B dealers Biological supply companies, Class B dealers (licensed animal brokers) - have used animal shelters, (licensed animal brokers) - have used animal shelters, strays, strays, "free to good home""free to good home" ads ads

Biological supply companiesBiological supply companies:: Inhumane killing practicesInhumane killing practices Injection of still-living animals with formaldehyde-Injection of still-living animals with formaldehyde-

based preservativesbased preservatives Numerous violations of the federal Animal Welfare Numerous violations of the federal Animal Welfare

ActAct

Adverse environmental impacts: Adverse environmental impacts: E.g., frog E.g., frog populationspopulations

Student experiences Student experiences of harmful animal useof harmful animal use

University of Illinois veterinary students, 1999:University of Illinois veterinary students, 1999:

"It was difficult to get any great understanding of physiology because we worried most of the time about not having our dog bleed to death or die of anesthetic overdose before the experiment was over. In the end, what I learned about physiology (cardiology and respiratory physiology) I taught myself from the notes."

“Most of us were too preoccupied with having to kill the dog that physiology wasn't concentrated on…”

“Nothing that was covered in those labs could not have been learned from a demo, or a video. The guilt I felt for participating outweighed all beneficial aspects of the experience.”

“The stress of the whole ordeal was worth nothing in the end. I studied from these books, not from my lab experience.”

“During one lab, my group accidentally killed our dog with anesthesia overdose because of lack of experience and the impatient ill-given advice of a professor. The experience overshadowed the benefit gained by the first lab.”

Conclusions: 59 % believed the non-survival animal physiology labs were not "worth the resources used". Only 20 % felt they gained "great benefit" in their understanding of physiology from the laboratories.

Veterinary associations survey 2005 - 2006

World Veterinary Association (WVA) American Veterinary Medical Association (AVMA) British Veterinary Association (BVA) New Zealand Veterinary Association (NZVA) Australian Veterinary Association (AVA)

Animal use practices

1. ‘Battery’ cages to house laying hens

2. Small crates to house ‘veal’ calves

3. Gestation crates to house pregnant sows

4. Cosmetic tail docking of dogs

5. The harmful use of animals in scientific research, toxicity testing and education

Outcomes Official veterinary positions lagged behind those of

the general public on important animal use issues: close confinement of laying hens in battery cages of veal calves in small crates of pregnant sows in gestation crates

Only practice condemned by most people and opposed by most veterinary associations: cosmetic tail docking of dogs (although the AVMA did not

take a firm stance against this)

A key cause: veterinary student

education

The importance of educating veterinary students about animal welfare issues and of assisting their development of critical reasoning skills is increasingly recognized

However, the proportion of veterinary students receiving such formal education remains small

‘‘Hidden curriculum’ endorsing Hidden curriculum’ endorsing harmful animal use harmful animal use

Anatomy (dissection, often of purpose-killed animals or animals from ethically-debatable sources)

Physiology, biochemistry and pharmacology (‘demonstration’ experiments on living animals, with animals usually killed during or after the experiment)

‘Terminal’ surgical and anaesthetic laboratories

Attitudinal impacts Attitudinal impacts

Majority of veterinary students receive minimal or no formal education in animal welfare issues or critical reasoning, and are directly required to harm and kill animals during their education

Unspoken messages: Harming and killing healthy animals is not only

condoned, but is required to become a veterinarian Animal welfare concerns are subservient to human

interests of debatable merit

Psychological impactsPsychological impacts

Negative underlying message about intrinsic value of animals’ lives

Stress may result in impairment of cognitive abilities, decreased learning, and loss of interest in the sciences

Desensitization to suffering and killing

Diminished capacity for compassion and ethical decision making

Veterinary student studies

Decreasing awareness of veterinary students of animal sentience (specifically, the hunger, pain, fear and boredom of dogs, cats and cows) over the duration of their veterinary courses (Paul and Podberscek 2000)

Decreased likelihood of fourth year students to provide analgesia when compared to second or third year students (Hellyer et al. 1999)

Inhibition of normal development of moral reasoning ability during the four years of veterinary school (Self et al. 1991)

Desensitisation-related phenomena

Psychological adaptations, enabling previously caring students to withstand psychological stresses, resulting from requirements to harm and kill sentient animals in the absence of overwhelming necessity

As well as directly saving substantial numbers of animal lives within veterinary curricula, the use of humane teaching methods are more likely to result in veterinary graduates with higher animal welfare standards, potentially benefiting their future patients.

Additionally, these veterinarians are more likely to become leaders, rather than followers, of evolving social standards on animal welfare, as expected by society

Therefore…

Conflict with studentsConflict with students

Legislative issues

E.g. Safia Rubaii, University of Colorado School of Medicine, 1995

Examples of US states with student choice legislation or policies:

California, Florida, Illinois, Louisiana, Maine, New York, Pennsylvania, Rhode Island.

Publicity issues

ConclusionsConclusions

Well-designed humane alternatives usually perform at least as well as methods that rely upon harmful animal use, in some cases achieving superior learning outcomes.

Educators can best serve their students and animals, and can minimize financial and time burdens, by introducing well-designed, humane teaching methodologies

Alternatives for various academic disciplines:

From Guinea Pig to Computer Mouse: Alternative Methods for a Progressive, Humane Education

www.InterNICHE.orgwww.clive.ed.ac.uk

Alternatives libraries, free on-line computer simulations, comprehensive alternatives databases, academic reviews of leading alternatives, and hundreds of educational studies of alternatives organized by discipline:

www.HumaneLearning.infowww.InterNICHE.orgwww.EURCA.org

Further informationFurther information