How Veterinary Students Prepare for Their First Surgery

Sonia Shah, V27, started feeling nauseous a week before her first spay surgery was scheduled. The surgery, part of the Introduction to Small Animal Anesthesia and Surgery Techniques (ISAAST) course at Cummings School of Veterinary School at Tufts University, is required for all third-year veterinary students, and it was all Shah could think about. She knew that the instructors wouldn’t let her do anything that would harm the dog, but she was terrified that she’d make mistakes and the instructors would have to step in to fix them. 

“It would be confirmation that I don’t belong in the field,” Shah said. “But once I got in there, I realized that even though I didn’t think I was prepared, I was. Everything I’d done in the three years leading up to that point had prepared me. And it was a really good feeling.”

A veterinary student’s first surgery is an intimidating milestone. It’s the first time they’re making an incision into a live animal, and it marks their transition from classroom learning into clinical medicine. At most veterinary schools, that surgery is a spay—removing the ovaries and uterus of a female dog. 

“There’s this inevitable anxiety around it, because it feels like the first time that you’re really doing something that is high stakes in vet school,” said Talia Aley, V27, who conducted her first two spays earlier this year.

Veterinarian Yuki Nakayama, assistant clinical professor at Cummings School of Veterinary Medicine, works with veterinary student Emma Fitzpatrick, V27, during a surgical procedure at the Luke and Lily Lerner Spay/Neuter Clinic. Photo: Alonso Nichols

The students work with dogs from local rescues, taking responsibility for everything from the intake exam to post-operative care, and conduct the surgeries under the supervision of an experienced instructor. 

Aley’s first dog, a larger lab mix named Kira, was in heat when she came in for the surgery. This changes the amount of blood flow to the reproductive organs and can make the surgery more difficult. Aley brought her concerns to Laurence Sawyer, D.V.M., V99, assistant teaching professor at Cummings School and director of the Luke and Lily Lerner Spay Neuter Clinic, who was overseeing the spay.

“She said, ‘Oh, you’re in for such an enriching experience and you’re going to get so much out of this,’” Aley said. “She did a great job of encouraging me and not making me worry more about it.”

With Sawyer’s advice and expertise on the more complicated aspects, Kira’s spay went smoothly. Aley left feeling like she had been given the support she needed to put her skills into practice. 

“I think I gained a lot of confidence in myself, and my ability to handle situations as they come up on the fly,” Aley said. “The whole experience was a really positive one.”

Veterinary student Sidney Neuman, V27, checks a patient's vital signs during a surgical procedure in the Lerner Clinic at Cummings School of Veterinary Medicine. Photo: Alonso Nichols

These days, most students in the class come away from their surgery experience with similar feelings. But that wasn’t always the case—Sawyer recalls her first spay as an experience to be survived, rather than something that made her excited to do more. She remembers fellow students walking away from their successful surgeries weak-kneed with relief rather than buoyed by a sense of accomplishment. 

“I wanted to change that attitude,” Sawyer said. “I personally find surgery very fulfilling and rewarding, and I want our students to be excited about it.”

Over the last few years, Sawyer and Yuki Nakayama, D.V.M., V14, assistant clinical professor at Cummings School of Veterinary Medicine, have been revamping the ISAAST course and more thoroughly integrating it with the rest of the surgical curriculum. The students have more opportunities to practice individual skills, rehearse the specific steps to a spay, bring concerns to an instructor, and receive constructive feedback. 

“We’re taking a more holistic approach that has helped better prepare students to succeed not only in this course, but also with clinics,” Sawyer said.

Veterinary student Olivia Santucci, V27, conducts a surgical procedure in the Lerner Clinic at Cummings School of Veterinary Medicine. Photo: Alonso Nichols

A spay surgery is one of the most common procedures that a general practice veterinarian will perform, but it’s also fairly complex. Students need to make an incision into a dog’s abdomen, identify the ovaries and uterus and separate them from surrounding tissues, tie off internal connections that could otherwise bleed, remove the reproductive organs, and suture everything back together, while making sure they don’t damage vital tissues and organs in the vicinity. 

Students learn some of the necessary surgery skills in their first and second years, but previously, those skills weren’t well linked to how students would need to use them during the spay surgery. Sawyer and Nakayama have begun introducing additional skills to students during their second year and making sure the students understand how to apply those skills during the spay and beyond. 

“I see this course as almost a capstone experience where they take all the things that they've learned before, that they've mastered in individual steps, and this is their opportunity to shine and put it all together,” Nakayama said. 

The instructors are trying to remove as much of the mystery from the spay class as possible and build an early rapport with the students so that they will be more comfortable asking questions. They have added online modules to both the clinical skills class and the ISAAST course to walk students through every step of the spay and have added office hours for students whose spay weeks are coming up. 

Ariana Hinckley-Boltax (at center), assistant teaching professor at Cummings School of Veterinary Medicine, works with a veterinary student during a surgical procedure. Photo: Alonso Nichols

Shah used the office hours to practice the suture patterns she would need to use during the surgery. Practicing on a silicone uterus isn’t exactly the same as a live animal, but it made her much more confident when she was working with the real thing.

Sawyer and Nakayama have made changes during the spay surgery days as well. The two instructors oversee all of the spays, so the students know exactly who they’ll be working with, and they have reduced the number of students per instructor. Students have several points during the surgery when they are required to check in with their instructor before proceeding, but they are invited to ask questions at any point. 

“I loved having them right there,” Shah said. “Both instructors very much embodied the ‘no stupid questions’ attitude and I felt very comfortable asking for help if I needed it.”

Veterinary student Jacob Moore, V27, conducts a surgical procedure with guidance from veterinarian Yuki Nakayama, assistant clinical professor at Cummings School of Veterinary Medicine. Photo: Alonso Nichols

Sawyer and Nakayama have also introduced a new feedback system. After their first surgeries, each student writes a reflection on how they think things went and what they’d like to work on. The instructor provides narrative feedback on the skills they observed and describes the ways the student can develop their techniques. This gives the students concrete areas to focus on improving the following day, during their second surgery.

The instructors know they can’t stop students from being nervous. But they hope they can make the spay surgery into an opportunity for students to realize what they’ve already learned, and identify new opportunities to grow as they continue in their careers. And it seems to be working. 

“The majority of our students come out of it with the biggest smiles on their faces,” Sawyer said. She credits both the additional preparation and the environment that the instructors have worked hard to build. “We’re not expecting them to come in and do the surgery perfectly. We’re expecting them to come with a good attitude and willing to learn. I think they understand and appreciate and embrace that. And it means they can come out the other side of it learning something, not just surviving.”