Policy for Surgical Procedures

Introduction

The Guide for the Care and Use of Laboratory Animals categorises surgical procedures by
several criteria, including type of animal involved (rodent versus non-rodent), invasiveness,
major and minor, and survival and non-survival. From a practical standpoint, this
classification scheme has been used to establish guidelines for the performance of
surgical procedures in research.

Definitions

 Survival surgery: a surgical procedure from which an animal is expected to regain

consciousness.
 Non-survival surgery: a surgical procedure from which an animal is euthanatized
before regaining consciousness.
 Major survival surgery: penetrates and exposes a body cavity or produces substantial
impairment of physical or physiologic functions. Examples include laparotomy,
thoracotomy, craniotomy, orthopedic procedures, limb amputation and enucleation.
 Minor survival surgery: does not expose a body cavity and causes little or no physical
impairment. Examples include wound suturing, peripheral vessel canulation, and
placement of subcutaneous implants.

Policy for Performing Non-Rodent Mammalian Survival Surgical Procedures

Qualified Surgical Personnel

All people involved with a study need appropriate training to adequately perform the duties
required of them. Training can be provided by the laboratory or through classes offered by
ULAR or individual departments.

Adequate surgical training must be provided to ensure that good surgical technique is
practiced including asepsis, gentle tissue handling, minimal dissection of tissue,
appropriate use of instruments, effective hemostasis and suturing techniques.

Individuals trained in human surgery may need additional training in interspecies variations
in anatomy, physiology, and the effects of analgesic and anesthetic drugs, or in
postoperative procedures.

Aseptic Technique

All survival surgery must be performed using aseptic technique. Aseptic technique
encompasses a number of practices and procedures to reduce microbial contamination of
surgical sites to the lowest possible practical level. In general, survival surgical procedures
should be performed using the same aseptic practices common in veterinary and human
medicine. The guidelines below are to be followed when performing survival surgery:

Surgical Area

Surgical areas must be maintained and operated in a manner that insures cleanliness and
minimizes unnecessary traffic.
For non-rodent mammalian species (e.g. rabbits, dogs, non-human primates, etc.), surgery
must be performed in an area specifically designated for that purpose, i.e. a surgical suite.
This area is typically divided into several functional areas: animal preparation, surgeons
scrub, operating room and postoperative recovery.

Surgeon

Preparation and attire of the surgeon includes the following:

 surgical scrub/hand washing
 standard surgical attire: mask, sterile gloves, gown and cap

Animal Preparation

The incision site should be prepared by removing all hair. If the hair is excessively dirty, the
animal may require bathing prior to clipping.

Usually after anesthesia has been induced, the hair should be removed. Typically, this is
performed by clipping with a #40 Oster blade, although a razor or depilatory cream may
also be used.

The area to be prepared should be approximately twice that needed for the incision, in the
event a larger incision than planned may be required.

The skin should then be cleaned and disinfected. A chlorhexidine or iodine-based

detergent (e.g. Povidone, Betadine) and a sterile gauze sponge can be used to scrub the
area.

It is important to remember the surgical site should always be cleaned by scrubbing along
the proposed incision line and then proceeding outward. The sponge should never be
brought from the contaminated edge of the surgical area back into the clean centre.

An ophthalmic ointment should be applied to the eyes to prevent drying.

The use of surgical drapes is required for non-rodent mammals.

Instruments

All instruments that come into direct contact with the surgical area must be sterile.
Sterilization of instruments can be achieved in a number of ways:
 steam (autoclave)
 dry heat (e.g. hot bead sterilizer)
 ethylene oxide
 chemical sterilants (Note, alcohol is not a sterilant.)

If surgeries are to be performed on consecutive animals, surgical instruments must be

sterilized between animals. This can be achieved by using multiple surgical packs,
chemical sterilants, or use of a hot bead sterilizer.

Post-surgical Care

Post-surgical care begins with recovery from anaesthesia, and may extend for days to
weeks depending on postsurgical outcomes and study design.
Postsurgical care, including after-hours and weekends, is the responsibility of the
investigator.

Postsurgical care includes the following:

 continuous observation to ensure uneventful recovery from anesthesia
 provision of supplemental heat during anesthetic recovery
 administration of fluids, analgesics and other medications as needed
 adequate care for surgical incisions

Veterinary Services (ULAR) is available to assist investigators with the planning of

postsurgical care, analgesic selection, etc.

Surgical Records and SOPs

Appropriate records of anesthesia, surgical procedure, and postoperative care must be

maintained for each animal undergoing surgery.

It is recommended that each investigator prepare a procedure-specific Standard Operating

Procedure (SOP) for each surgery protocol.

The SOP and the approved IACUC protocol for the surgery should be posted or otherwise
readily available to all personnel in the laboratory.

Examples of a rodent surgical SOP and a surgical record are provided.

Policy for Aseptic Rodent Surgery

General Guidelines for Survival Surgery on Rodents

Rodent surgery for research, teaching, or testing purposes must be conducted according
to a protocol approved by the IACUC. Federal regulations require that all survival surgeries
on rodents be performed by using aseptic procedures; however, a dedicated surgical
facility is not required. (1)

Surgery must be performed or directly supervised by trained, experienced personnel.

Inexperienced personnel must receive training in aseptic surgical techniques, available
from the University Laboratory Animal Resources (ULAR) veterinary staff.

Aseptic Procedure

Aseptic surgical procedures are designed to prevent postsurgical infection due to microbial
contamination of the incision and exposed tissues. Infections in rodents can be subclinical
but still affect the behavior and/or physiology of the animal. Prevention of infection
improves the welfare of the animal and eliminates a source of uncontrolled variation in the
experimental results. The following guidelines for aseptic procedures should be followed
when performing survival surgery on rodents:

Surgical Area: Rodent survival surgery does not require use of a dedicated surgical suite.
The area designated for rodent surgery must be clean, disinfected, and free of clutter and
debris. In addition, the surgical area must not be used for any other purpose during the
time of surgery.
Surgeon: Sterile gloves must be worn by the person performing the surgical procedure.
Gloves should be changed between animals or if they become contaminated. A mask and
a clean lab coat or scrubs are also recommended, but not required.

Animal Preparation: The incision site must first be prepared by removal of hair and
decontamination of the skin.

After the animal is anesthetized, hairs should be removed from the surgical site. Electric
clippers with a #40 blade, a razor or depilatory cream may be used.

The area to be shaved should be twice that expected for the surgical area in the event that
a larger incision than planned may be required.

The skin should then be cleaned and disinfected. A chlorhexidine or iodine-based soap
(e.g. Povodine, Betadine) and a sterile gauze sponge can be used to scrub the surgical
site.

The surgical site should be cleaned by scrubbing along the incision line, then proceeding
outward. The sponge should never be brought from the contaminated edge of the surgical
area back to the clean center.

Animals prone to skin inflammation require special attention, as do animals undergoing

surgery in areas that are difficult to keep clean.

A bland ophthalmic ointment should be applied to the eyes to prevent drying.

The use of surgical drapes is recommended for rodent surgery.

Instruments: All instruments that come in direct contact with the surgical site should be
sterile. Steam (autoclave), dry heat, ethylene oxide or chemical sterilants, (not
disinfectants), can be used to sterilize surgical instruments prior to surgery.

The experimental design may require repetitive surgeries (i.e. performing the same
surgical procedure on a number of rodents at the same time.) In this case, surgical
instruments must be sterilized between animals. This can be achieved by using multiple
surgical packs, chemical sterilants, or use of a hot bead sterilizer. (Note. alcohol is not a
sterilant.)

Post-surgical Care

Trained personnel and appropriate facilities and equipment must be available for
postsurgical care. Post-surgical care includes the following:
 continuous observation to ensure uneventful recovery from anesthesia.
 provision of supplemental heating.
 administering of supportive fluids.
 analgesics and other drugs, as necessary.
 adequate care for surgical incisions.

Records and SOPs

Appropriate records of the anesthesia, surgical procedure, and postoperative care must be
maintained. It is recommended that each investigator prepare a procedure-specific
Standard Operating Procedure (SOP) for each surgery protocol. The SOP and the IACUC
approved protocol for the surgery should be posted or otherwise readily available in the
laboratory.

Policy for Nonsurvival Surgical Procedures

Definition: a surgical procedure from which an animal is euthanatized before recovering

consciousness.

For studies in which local bacterial contamination of tissues, or sepsis, could influence
study outcomes, standard aseptic technique is recommended. Such studies include long
term (>8 hours) terminal surgeries and collection of samples for tissue or microbial culture.

At a minimum, it is recommended that lab personnel wear dedicated clothing (e.g. lab
jacket), gloves, and other appropriate personal protective equipment when euthanatizing
animals for tissue collection. In addition, the area used for tissue collection should not be
used for other purposes during the tissue collection and the area should be cleaned and
disinfected after each use.
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INTEGRATING ALTERNATIVE MODELS INTO THE EXISTING SURGICAL

CURRICULUM

Introduction

Historically, surgery was taught to veterinary and medical students through the use of live
animals on which multiple surgical procedures were taught over one or more successive
weeks. As humane care of laboratory animals became a more important issue, many
institutions moved away from this practice. Currently, some veterinary schools conduct
surgery laboratories where the animal survives one or more minor procedures and is
euthanized at the termination of a major surgical procedure. Other institutions teach
surgery to veterinary students without survival surgery laboratories (1).

Use of live animals for veterinary surgical education has come under scrutiny by many
people, including animal rights organizations, veterinary students, and veterinary surgical
educators. Concerns include the large number of animals which are euthanatized yearly
for this purpose, the need to use these animals for this purpose, and the cost of
purchasing and housing these animals. The current trend is to decrease or eliminate
unnecessary or excessive use of live animals for teaching purposes and replace the live
animal use with alternatives. An alternative is acceptable for teaching if it allows the
student to reach at least the same level of proficiency as obtained when the same
procedure is taught in a traditional manner. Ideally, this level of proficiency is also
adequate for the student to practice clinically after graduation from veterinary school.

Alternatives Used in Surgery Labs at The University of Illinois

At The University of Illinois, we have made humane issues a priority in our surgical
teaching program and we have taken a pro-active attitude. We have tried to alter our
program of surgical education to meet the needs and desires of the veterinary students,
society and the surgical educators. While changing our laboratory curriculum we have also
tried to maintain the goal of providing the best surgical education possible. We have not
had any students who have requested participation in an alternative program instead of
our regular surgery course even though an alternative program is in existence at our
institution. We feel that the incorporation of alternatives into our standard teaching
program and the decreased use of live animals in surgery laboratories may be partially
responsible for student acceptance of our program.

Many changes were made in our small animal surgery laboratories over the past 10 years.
The initial change, which occurred in the early 1980s, was from multiple survival
procedures on one animal to one survival procedure per animal. The single survival
laboratories were set up so that one procedure was performed on an animal, followed by
one week of survival, a more invasive surgery was then performed and the animal was
humanely euthanatized at the end of the second laboratory (Table 1).
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Table 1. Surgery Laboratories: 1985-1986. (S = survival, NS = non-survival)

Laboratories Animals
Gowning, gloving, patient preparation, incisions S
Exploratory laparotomy NS
Gastrotomy, cystotomy S
Enterotomy, intestinal resection/anastomosis NS
Ophthalmic surgery NS
Cystotomy, ovariohysterectomy S
Thoracotomy NS
Cervical disc fenestration S
Approach to hip and pelvis NS
Approach to humerus and elbow S

--------------------------------------------------------------------------------

During the 1988 to 1989 school year, the surgery laboratory curriculum was revised to
emphasize basic techniques and skills (Table 2). The introductory laboratories on aseptic
technique, gowning, gloving, etc., which had previously been taught separately in large
and small animal surgery courses, were combined. Additionally, alternatives to live animal
use were introduced where appropriate. One of the first alternatives that was incorporated
into the laboratory was the use of purchased slaughtered chickens as a model for suturing
on tissues instead of using live, anesthetized dogs for skin incision and suturing
instruction. Suturing on chickens allowed the students to begin to get the feel of suturing in
tissues without the use of live animals. It also allowed students to begin to develop good
tissue handling skills and manual dexterity and proficiency. We feel that the learning
experience gained from the suturing practice on purchased chickens is so beneficial that it
remains a part of our surgery laboratory program.

Also added in the 1988-1989 year was a laboratory using bones harvested at a previous
terminal laboratory as an introduction to fracture repair (Table 2). The bones were used to
teach proper techniques for placement of pins and wires, for teaching principles of fracture
repair, and for practice of repair of specific types of fractures. Additionally, plastic bones
made by Sawbones(R) were used for laboratories when harvested bones were not
available and for models of pathologic conditions (2, 3). The success of these bone
models for the instruction of orthopedic principles and techniques in psychomotor
laboratory settings has been documented (2-4).

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Table 2. Surgery Laboratories: 1988-1989. (NA = no animals used, S = survival, NS = non-
survival)

Laboratories Animals
Scrubbing, gowning, gloving, patient preparation NA
Draping, instrument handling, packs, sterilization NA
Incisions, hemostasis, ligation, suturing, knot tying Chickens
Exploratory laparotomy S
Splenectomy, gastrotomy NS
Enterotomy, intestinal resection/anastomosis NS
Thoracotomy NS
Ovariohysterectomy, cystotomy S
Salivary gland surgery, lateral ear canal resection NS
Approach to humerus and elbow S
Approach to stifle NS
Introduction to fracture repair Bones

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In 1989-1990, the laboratories were revised to place more emphasis on procedures that
are commonly performed in small animal practice (Table 3). Less frequently performed
procedures were no longer taught and more emphasis was placed on neutering
procedures, declaws, and basic orthopedic procedures and techniques. The total number
of laboratory periods remained unchanged. A new program was instituted in the small
animal surgery laboratories. A neutering program with a local humane shelter was
developed in which adoptable dogs and cats were brought to our facility for neutering.
Prior to surgery, all animals received a complete physical examination, fecal examination
for intestinal parasites, and the routine preoperative blood work for young healthy animals
(including a packed cell volume, total protein, and blood urea nitrogen determinations). All
dogs were heartworm tested, and all cats were feline leukemia tested. Animals with
abnormalities were treated appropriately. Elective neutering procedures
(ovariohysterectomy or castration), and declaw (when requested on selected cats), were
performed by the junior veterinary students in the surgery laboratory. All animals were kept
in the hospital for observation and postoperative care by the student surgeons for 3 days
to 1 week after completion of the surgery. The animals were examined by the students
twice daily and a faculty member at least once daily during the postoperative
hospitalization period. The students treated postoperative complications which developed.

The humane shelter program has been very well received by the students. They like the
exposure to the elective procedures that they need to be competent in upon graduation;
they are happy about being able to provide this service to the community; and they feel
that following survival surgeries has been beneficial. An additional positive note is that the
humane shelter adopts more animals when they have already been neutered. This
program has been so successful that we are currently working with a second humane
shelter.

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Table 3. Surgery Laboratories: 1989-1990. (NA = no animals, S = survival

NS = nonsurvival, S-HS = survival, humane shelter animals)
Laboratories ---- Animals
Scrubbing, gowning, gloving, patient preparation ---- NA
Draping, instrument handling, packs, sterilization ---- NA
Incisions, hemostasis, ligation, suturing, knot tying ---- Chickens
Splenectomy ---- S
Ophthalmic surgery ---- NS
Enterotomy, intestinal resection/anastomosis ---- NS
Ovariohysterectomy x 3 ---- S-HS
Castration (canine and feline)/declaw ---- S-HS
Approach to stifle and humerus ---- NS
Introduction to fracture repair ---- Bones

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The addition of the humane shelter neutering program into our junior surgery laboratory
schedule has also provided an economic advantage over purchasing dogs for use in the
laboratory. The cost of purchasing and housing a dog for one nonsurvival surgery at our
institution is approximately $175. The costs incurred for neutering a dog from the humane
shelter is approximately $50 and varies slightly depending on how many days the animal
stays hospitalized postoperatively.

The elective neutering program has also been incorporated into our 4th-year clinical
rotations. When time permits, senior veterinary students perform these procedures to gain
extra surgical experience and to become more competent. Additionally, new interns
perform elective neutering surgeries on the humane shelter animals early in their
internship year to gain experience before instructing the students.

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Table 4. Surgery Laboratories: 1991-1992. (NA = no animals, NS = nonsurvival, S-HS =

survival, humane shelter animals)

Laboratories ---- Animals

Scrubbing, gowning, gloving, patient preparation ---- NA
Draping, instrument handling, packs, sterilization ---- NA
Incisions, hemostasis, ligation, suturing, knot tying ---- Chickens
Splenectomy ---- NS
Enterotomy, intestinal resection/anastomosis ---- NS
Cystotomy/gastrotomy ---- NS
Ophthalmic surgery ---- Cadavers
Oral surgery, dentistry ---- Cadavers
Approach to stifle ---- Cadavers
Ovariohysterectomy x 2 ---- S-HS
Castration (canine and feline)/declaw ---- S-HS
Introduction to fracture repair ---- Bones
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In 1991-1992, two existing laboratories were changed to the use of cadavers (Table 4).
These were the ophthalmic surgical laboratory and the laboratory for the approach to the
stifle. For the stifle laboratory, legs harvested at previous terminal surgery laboratories
were frozen. Prior to the laboratory, the legs were thawed and were used for instruction of
approaches to the stifle joint and for performing certain surgical procedures such as
surgical correction of patellar luxation and cranial cruciate ligament rupture. We have
found this to be satisfactory.

A dentistry and oral surgery laboratory using cadavers was added to the core small animal
surgery curriculum in 1991-1992. Jaws with associated soft tissues were harvested from
animals euthanatized at a previous terminal laboratory. The jaws were hemisected and
frozen until the day that they were to be used. Students worked in pairs on the thawed
jaws. Procedures which were performed included oral examination and dental charting,
radiography, scaling and polishing, simple, multi-rooted, and complicated surgical
extractions, and oronasal fistula repair. This laboratory fulfilled the need for training
students in dental prophylaxis and routine procedures, and has also been very well
received by the students.

Our current small animal surgical laboratory schedule is the same as the 1991-1992
schedule (Table 4). It consists of 2 laboratories covering the essentials of aseptic
technique, patient preparation, and instrument handling. There are 5 laboratories using
alternatives (1 with chickens, 1 with bones, and 3 with cadavers). There are 3 nonsurvival
laboratories which involve laparotomies which allows each student to perform one
approach and abdominal procedure on an animal that is euthanized prior to performing a
survival abdominal procedure. Finally, there are 3 survival neutering laboratories using
humane shelter animals which are returned for adoption. These laboratories allow each
student to be primary surgeon once on a survival procedure; to observe the outcome of
the procedure; and to practice appropriate postoperative care prior to being responsible for
client animals in the 4th-year surgery rotations.

During the past 3 years, we have developed a set of realistic soft tissue models (5). The
initial models that were developed were canine spleen, kidneys, and liver, followed by
canine stomach, gall bladder, pancreas, small and large intestine, urinary bladder, and
uterus. Additionally a canine body cavity model was made. The next step in the transition
of our teaching laboratory is to incorporate the use of soft tissue models into the
laboratory. Student performance on the models and teaching effectiveness of the models
in the laboratory setting will be evaluated. Student surgical performance will be evaluated
in the clinical year to determine if learning on these models is acceptable. A trial laboratory
using models was conducted in 1992-1993. Results from this study are still being
analyzed. If the results indicate that the soft tissue models are successful tools for
teaching surgery, it is our hope to replace the nonsurvival laboratories currently in our
curriculum with laboratories using soft tissue models by the 1993-1994 year.

Survey of Veterinary Students Regarding Surgery Laboratories

Students were surveyed yearly at the end of the small animal surgical laboratories about
the use of live animals and alternatives in the teaching laboratories and to monitor student
acceptance of models as teaching tools. The questions asked were: 1) What are your
feelings concerning the use of live dogs for learning surgical principles and procedures in
the laboratory? 2) What are your feelings concerning survival surgeries in the laboratory?
3) What are your feelings concerning the use of appropriate alternatives (models, others
species, cadavers) for learning surgical principles and procedures in the laboratory?
Answers to survey questions were rated on a scale of 0 to 5, with 0 being very negative
and 5 being very positive. Comments about the laboratory experience and the use of
models were also solicited.
Mean scores (± SD) of student responses to the survey questions from 1986-1989, and
1991-1992 years were calculated. Mean values of student responses between the different
survey years were compared using the Welch's alternate t test. Mean values were
considered to be statistically different if p < 0.05.

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Table 5. Mean scores (± SD) of student responses to survey at end of small animal
surgery laboratories.

1986-1987 A 1987-1988 B 1988-1989 C 1991-1992 D

No. of 33 65 85 36
students
Question 1 4.08±1.27* 4.47±1.16 4.37±0.85* 4.65±0.63
Question 2 3.50±1.47*,+ 4.15±1.31* 4.05±2.35* 4.92±0.28
Question 3 2.23±1.84*,# 2.99±1.77# 3.74±1.37 3.61±1.54

A- Single survival surgeries followed by euthanasia after second

procedure, no alternative models in these laboratories.
B- Laboratory schedule same as 1987 year.
C- Chicken and bone models incorporated into laboratory, emphasis placed
on teaching basic techniques.
D- Ophthalmic surgery and orthopedic procedures changed to be performed
on cadavers, dental procedures and oral surgery laboratory on cadavers
added, chicken and bone models continued, survival neutering procedures
on humane shelter animals incorporated into laboratory, no other
survival surgeries.
*- Significant difference when compared to results of same question in
1991-92.
+- Significant difference when compared to results of same question in
1987-88.
#- Significant difference when compared to results of same question in
1988-89.
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Students had generally positive feelings about the use of live animals for learning surgical
principles and procedures (question 1) with mean scores >4 during each year of the
survey (Table 5). There were statistically significant elevations of the mean scores for
question 1 when the 1986-1987 and the 1988-1989 years were compared to the survey
results of the 1991-1992 year. Changes in the curriculum which may have influenced these
survey results included the addition of the humane shelter neutering program, decreased
use of live animals for other laboratories and the increased use of alternative models over
this time period. More appropriate use of live animals in the teaching laboratories appears
to have made the students' live-animal surgical experience more positive. Comments
about question 1 from all years reflected a strong feeling that some live-animal experience
was necessary to learn surgery and that live-animal surgical experience could not be
completely replaced by models. In the 1992 surveys, the issue of unnecessary use of
animals in teaching laboratories became apparent. Many students commented that live-
animal surgeries were necessary and important, but that acceptable alternatives (such as
the cadavers used in the dental and the ophthalmic laboratories, and harvested bones and
legs for orthopedic procedures) should be used whenever appropriate. Comments such as
these were only sporadic in the surveys from earlier years.
The responses to question 2 indicated an overall increase in the acceptance of survival
surgeries in the laboratory during the survey period (Table 5). Survival humane shelter
neutering procedures were added to the laboratories and all other survival laboratories
were eliminated between the first three years and the last year of the survey. There were
significant increases in mean scores when the first three years (1986-1987, 1987-1988,
and 1988-1989) were each compared with the mean score from the last survey year
(1991-1992). Student reaction to the humane shelter neutering program was very
favorable. Students felt that neutering of shelter animals was a valuable experience and
that they learned by observing their patients during the postoperative period while
providing a service for the community. Additionally, the students were pleased with the
increased emphasis placed on surgical procedures (elective neutering) which all students
felt that they needed to be competent in at the time of graduation. There was also a
significant increase in the mean scores of question 2 between the 1986-1987 and the
1987-1988 years which is difficult to explain since the laboratory curricula were the same
during these two years.

Prior to incorporating alternative models into the small animal surgery laboratory, many
students had negative feelings about substituting models for live animals. Initial responses
about the use of appropriate alternatives in the teaching laboratory (question 3) were low
(Table 5). After models and alternative teaching methods were incorporated into the
laboratories and students were exposed to them (during the 1988-1989 year), student
acceptance and mean scores for question 3 significantly increased (between the 1986-
1987 and 1988-1989 years; the 1986-1987 and 1991-1992 years; and between the 1987-
1988 and 1988-1989 years). Comments about the use of appropriate alternatives in the
laboratory have continued to be positive. However, two problems have been repetitively
encountered in the response to this question. The first is that the students feel that the
models that they have been exposed to are appropriate and acceptable, but that it would
be impossible to substitute additional models for other laboratories. The second problem is
that every year there have been students who write favorable comments about the
models, but who also score 0 or 1 on this question and comment that live-animal surgeries
cannot be replaced by alternatives. Based on the survey results and discussions with
students, we feel that students react favorably to the alternative models that they have
been exposed to, but they are also apprehensive about expressing too much positive
sentiment for fear of losing all of their live-animal surgery experience.

Discussion

Several factors affect implementation of alternative methods of teaching. The skills that
were previously taught using live animals should be equally or better learned on the
alternatives. The objectives of the laboratory and how these objectives will be
accomplished on the alternative model should be defined. Clinical relevance of the model
and of the techniques and procedures being taught should be established to ensure
student acceptance of the alternative method and model.

The use of alternatives to live animals should be presented to the student in a positive
fashion and one which justifies the changes. Although there are many students who
question the use of animals strictly for learning surgery, there are more who feel that
learning on live animals is the only acceptable way. As alternative methods are introduced
and the number of live-animal laboratories decreased, it is not uncommon for students to
feel that the educators are trying to cheat them out of a valuable learning experience and
that they will not be prepared to go into clinical practice after graduation without this live-
animal experience.
Advantages of models over the live animal include the availability of models at all times;
that all students can perform each procedure (rather than being surgeon, assistant
surgeon, or anesthetist as is currently done in live-animal laboratories); and that
procedures can be repetitively practiced until an acceptable level of proficiency has been
reached. Manual dexterity and surgical proficience can be mastered on the inanimate
object without the pressure and anxiety felt during live-animal laboratories. The student
who has practiced on models should be better prepared for live-animal surgery. The
students must understand that the purpose of teaching on models prior to live animals is to
make them better, more competent surgeons when they perform their first live-animal
surgeries and that there is no intention on the part of the faculty to replace all live-animal
surgery laboratories with laboratories using models.

An essential part of a surgical teaching program such as ours is the incorporation of a

neutering program with a humane shelter. The humane shelter program gives the students
the necessary exposure to live-animal surgery and patient care prior to work on privately
owned animals.

The changes that we have made in our curriculum have involved a gradual integration of
alternative models and teaching methods into an established curriculum. The results of our
student survey are encouraging and show that our students approve of the changes in our
curriculum. Over the course of the survey period responses to all three questions have
significantly increased. The high mean scores (>4) for question 1 over all years surveyed
indicate that live-animal surgical experience is important to the students. The most positive
responses, and significant increases in the mean scores, occurred following the addition of
appropriate models and of the humane shelter neutering program. This supports our
contention that it is the appropriate use of live animals in the teaching laboratory that is
most favorably looked upon by the students.

Mean increases for question 2 on the survey indicate that students feel that survival
surgery is a very good learning experience. Additionally, survival surgery is accepted and
supported almost unanimously by the students when there is a purpose (neutering animals
that will later be adopted) in addition to just practicing a surgery. Responses after
incorporation of the humane shelter program were significantly higher than responses
addressing other survival surgeries.

Our students also feel that alternative models can be a useful part of a surgical teaching
program as evidenced by the responses to question 3. Interestingly, students' opinion of
models improved significantly only after they had been exposed to the use of models in a
laboratory situation. This confirms our feeling that it is difficult for students to accept new
applications of alternative models. However, once they are exposed to new models and
have first-hand experience with using a certain model in a learning situation, they are
receptive to further use of this model and models in general.

This paper chronicles the evolution of a veterinary surgical teaching program which has
progressed from laboratories involving multiple survival surgical procedures to one which
uses a minimal number of animals and several alternative models to provide instruction. It
also demonstrates the changes in our students' opinions about the use of live animals,
survival surgery and alternative models in the teaching laboratory during this period of
curricular change. Over the next few years, our surgical laboratory curriculum will continue
to evolve to the point of having no nonsurvival surgical laboratories. The elective neutering
procedures on humane shelter animals will be used for all instruction of live-animal surgery
and postoperative patient care during the 3rd-year surgical laboratories. As our surgical
laboratory program continues to evolve, we will continue to monitor student performance
during both the 3rd-year teaching laboratories and during the clinical year of training. We
will also continue to monitor student acceptance and effectiveness of the alternative
models and methods of teaching.

Summary

The surgery laboratory curriculum at The University of Illinois has evolved over the past
ten years. Changes were made to address animal welfare concerns as well as the needs
of the veterinary students and surgical teaching faculty. Some of the traditionally taught
terminal animal laboratories were replaced with appropriate alternative teaching methods.
Student response to the use of live animals and alternative teaching models in surgery
laboratories has been monitored.

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