Clinical skills emphasized from day one
posted April 18, 2011
Dr. Andrea Peda, assistant professor of small animal clinical
practice, teaches students about proper aseptic technique in
the clinical skills laboratory.
About five years ago, the entire faculty at Ross University School of Veterinary Medicine met to draft an educational plan that would include the key things they want their ideal graduates to understand, what they should be able to do, and who they should be. The faculty established endpoints, then worked backward so that students would begin pursuing those endpoints in their first semester. This included making sure students were clinically and professionally skilled in providing care to both individual, and populations of, animals.
Basic science courses were revamped so that now, the students are taught in a much more applied manner with an eye toward touching on specific competencies and interacting with community practice clinicians in the first semester.
In anatomy, for example, first- and second-semester students are split into groups of six. On any given day, members of the group perform palpations and dissections, study freeze-dried and labeled prosections, conduct live-animal palpations, or view radiographs. Once a week, the entire class attends lectures devoted to overarching topics in anatomy.
"In the past, we made many assumptions that the ability to master surgical skills were innate qualities. When you've been doing it a while you assume someone coming in will quickly pick it up without real thorough, basic instruction."
—DR. ERIC R. POPE, PROFESSOR OF SURGERY AND SECTION CHIEF OF SMALL ANIMAL CLINICAL SCIENCES, ROSS UNIVERSITY SCHOOL OF VETERINARY MEDICINE
"Faculty try to parallel what's happening in the dissection laboratory with the palpation area and clinical skills lab," said Dr. Gilbert A. Burns, dean of faculty and academic programs. "Students are engaging in medical activities during the first week of class."
Dr. Eric R. Pope, professor of surgery and section chief of small animal clinical sciences, and his colleague, Dr. Claire J.A. Spackman, professor of surgery, altered their courses by stressing skills and principles over procedures.
"In the past, we made many assumptions that the ability to master surgical skills were innate qualities. When you've been doing it a while you assume someone coming in will quickly pick it up without real thorough, basic instruction," Dr. Pope said. "We didn't critically look at competencies. Yes, they could get through a procedure, but maybe it wasn't optimally performed. Correcting errors in basic skills when they're in the middle of surgery is not a good time for a student to absorb that information, and you can only correct it one time."
So the school built a clinical skills laboratory in 2008 dedicated to providing students with the necessary psychomotor and clinical skills. Students start as early as their first semester learning basic veterinary skills on models, including instrument handling, suturing techniques, and ligation skills. Using models allows students to practice repetitively in the laboratory and perfect their skills. Instructors provide constant feedback while the students work in small groups with a student-to-instructor ratio of about 8-to-1.
Before students are allowed to participate in the hospital spay program, their skills and understanding of aseptic technique are evaluated by having them perform an ovariohysterectomy on a model dog abdominal surrogate for instructional exercises, or DASIE, developed at the University of Guelph Ontario Veterinary College.
Dr. Eric R. Pope, professor of surgery and
section chief of small animal clinical sciences
at Ross University School of Veterinary
Medicine, helped develop the Rossie model
(inset) that students use to practice their
surgical skills. "Beyond that basic simulation
of closing tissue layers and the toughness
of tissues, we can simulate that experience
(of surgery). Our model, plus with the uterine
model, mimics what it's like to remove ovaries
and uterus," Dr. Pope said.
It's an hourlong examination in which one student at a time is tested on his or her surgical skills in front of a faculty surgeon. In advance, the students receive a copy of the scoring rubric and undergo a mock examination, so they know exactly how the professors will evaluate them.
Though the faculty is still assessing outcomes, Dr. Pope said it seems to be working.
"Now, when they are doing hysterectomies, we have fewer technically related errors such as not tying a knot securely or not applying instruments correctly. The students are now more confident, because they understand the skills to perform the procedure. So even though it's their first time, we have fewer problems," he said.
Dr. Richard L. Meadows has been a teaching professor for 12 years in small animal community practice medicine at the University of Missouri-Columbia College of Veterinary Medicine, which is one of the 22 affiliated U.S. veterinary schools and colleges that work with Ross students.
He says their degree of preparedness is markedly better now than it was when he started teaching at the clinic.
"As a whole, over the last several years we've been really pleased with the quality of the basic education" of Ross students, Dr. Meadows said, and he hasn't noticed any substantial differences in their clinical skills from those of other students.