The laboratory will offer hands-on experience for students to build their confidence and surgical skillset as veterinarians
The Joseph Kelley, DVM Simulation Laboratory at Cummings School of Veterinary Medicine has officially opened as a newly renovated 3,000-square-foot space next to the Luke and Lily Lerner Spay/Neuter Clinic, designed to help veterinary students develop hands-on skills and enable them to feel competent and confident in their clinical abilities.
Several years in the making, it started with inspiration from faculty members teaching hands-on skills and from veterinary students seeking more experience with procedures and surgeries. Cummings School sought to create a model where a student learning a procedure, such as spay/neuter or dentistry, could effectively practice these skills with a realistic simulation.
With this space, for example, a student preparing for a live animal surgery, perhaps for their third-year surgery lab, can practice the procedure ahead of time with multiple repetitions.
“We wanted the lab to be accessible for students, both during class and outside of class on their own time, throughout all four years of the curriculum to help them become excellent veterinarians,” says Nicholas Frank, associate dean for academic affairs and professor of large animal medicine. “The lab’s location next to the Lerner Clinic means that students can walk between the two without having to leave the building, creating synergy between what we teach in the simulations and practice in the hospital.”
The laboratory’s namesake, Joseph Kelley, DVM, was a friend and mentor to Cummings School alumni, and a generous $5 million gift in his memory along with support from many friends and alumni enabled not only the construction of a multifunctional laboratory, but provided about $750,000 to purchase simulators and a $2 million endowment to support its ongoing operation. The lab includes room for students to practice on a number of different models, as well as space for producing the models themselves. These include low-fidelity examples built by Joe Popowski, a longtime teaching technician, and high-fidelity 3D-printed simulators designed by Michael Karlin, assistant professor of small animal surgery.
“The low-fidelity models basically look like a cylinder with various layers of coverings on it that simulate the skin and tissues,” explains Frank. “It’s not important for the low-fidelity model to look like a cat or dog because during the simulation, most of it will be covered in draping, and students will see only the undraped section where they will make the incision.”
“The plan is for 3D-printed models to be used in the simulation lab to expand the breadth of procedures we teach our students,” says Karlin. “For example, we can print models to simulate clinical problems, such as abnormal vasculature or limb deformities, which will provide our students with well-rounded exposure during preclinical and clinical years with the goal of making them competent, day-one-ready veterinarians.”
Learning Before Doing
Emily McCobb, V00, VG02, clinical associate professor of anesthesiology, was an early champion of the simulation lab, and now she and Ariana Hinckley-Boltax, assistant professor of clinical skills, are among the first faculty members to incorporate the simulation lab into their coursework.
Hinckley-Boltax runs the year-long clinical skills courses required for all first- and second-year students, in which they learn “basically anything a veterinarian does with their hands,” she says, including how to put on a gown and gloves in a sterile environment, hold instruments, draw blood, place intravenous catheters, stitch a variety of sutures, perform CPR, give a general physical exam, conduct an ultrasound, and more.
“The approach is to create a positive learning environment for students that replicates real veterinary hospitals but where they can experiment, practice, get feedback, and work with their peers in a safe space,” says Hinckley-Boltax.
“The simulation lab will expose students to a clinical setting from their first year, and our hope is that this will make them more comfortable in the space,” says McCobb. “The first time they have to perform a procedure or surgery, it’s very stressful. Intangible things like being in a familiar space and knowing where the supplies and tools are help reduce that stress. Even the lights look the same as in the hospital operating room.”
McCobb works with third-year students during their required anesthesiology course and fourth-year students who take a surgical skills elective. In the anesthesia class, students practice in the simulation lab placing IV catheters in rubber canine forelimbs to improve their fine motor skills and establish muscle memory. The legs have little tubes in them to simulate the blood vessel the student must find and poke. By the end of their third year, students will repeat the procedure on a real dog.
“When a student is on their anesthesia rotation at the hospital, they need to place and tape the catheter the same way they learned it in the lab,” says McCobb. “As we teach students how we do these things in the hospital, there are opportunities to look at protocols, best practices, and standardization of techniques.”
Students are encouraged to work in the simulation laboratory outside of class time to practice on the models with their peers. It’s a great opportunity for feedback and for repetition, says Hinckley-Boltax.
“It’s basically a peer-assisted clinical-instruction model,” says Frank. “Students run labs on the weekends where they practice suturing and other procedures. Students who are further along in school teach the students in the class years below them. This is how we want the sim lab to be used outside of regularly scheduled classes.”
McCobb notes that, while some veterinary students come to Cummings School with prior experience as a veterinary technician or nurse, the simulation lab can be particularly beneficial for students who do not have such experience. All students, regardless of prior experience, must perform a spay procedure on a model at the end of their second year and on a live dog or cat in their third year.
The approach is to create a positive learning environment for students that replicates real veterinary hospitals but where they can experiment, practice, get feedback, and work with their peers in a safe space.
The lab is equipped with cameras and screens that will allow for procedures to be recorded and peer reviewed. Students have the option of watching the recordings to evaluate themselves. “Nothing builds a student's confidence and competence like looking at a surgery or procedure and evaluating what could have been different and what went well,” says Karlin. “What really matters is that students grow their skillset from when they start in the simulation lab to when they finish years later.”
Advancing Skills, from CPR to Surgery
The lab also has a dedicated area for CPR training, and in their first year, students use low-fidelity models to learn basic life support skills, such as establishing an airway and starting chest compressions. “They practice putting their hands in the right place, compressing the chest to the right depths, keeping the right timing, and passing a tube to put breaths into the chest,” says Hinckley-Boltax. “Simple things, but really critical because if they aren’t correct, the CPR won’t be successful.”
In the second year, advanced life-support training steps it up a notch with a model dog—named Robo Jerry—which connects to a computer that runs a program to simulate a crisis. Instructors can set up a simulation to trigger the model to suddenly decompensate, forcing the student participants to respond accordingly. The program provides data about the dog’s condition, and students learn how to diagnose arrest rhythms on the electrocardiogram, administer certain drugs, and consider the details of a clinical situation and how that might change the actions required to save that life.
“We can put the student through a situation they have to adapt to, and the point isn’t to make it stressful, but to challenge them with some of the potential complications in this safe environment where there isn’t a bad outcome because there’s no animal involved,” says Frank.
The lab can accommodate simulations on advanced surgeries, as well, such as removing a foreign body or an organ. But to get there, Frank notes, students advance through many steps and commit to the training. The lab’s highest-fidelity model, a canine SynDaver, simulates a realistic surgery, complete with blood and hemorrhaging. The deal is that advanced students get to use the SynDaver, but in exchange, they must train first-year students on suture lines and other basic skills.
Moving forward, the expectation is that the lab will be used by faculty and students, and incorporated into Cummings School’s robust training program for interns and residents. It may also be used for continuing education events.
“There are many ways that this lab can be used,” agrees McCobb. “From our students on their first day to continuing education for the veterinary community, it’s pretty much limitless.”