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April 2023
Virtual Learning In Person
New virtual lab at Tufts University simulates the full clinic experience
New Virtual Lab at Tufts University Simulates Full Clinic Experience
Imagine a veterinary school experience in which students can practice their skills on high-fidelity simulators that look, feel, breathe, and react like live animals. Instructors can also set up crisis scenarios, allowing students to react, and if they make a mistake, they can redo life-saving techniques without causing harm to a live animal.
The Joseph Kelley, DVM, Simulation Laboratory at Cummings School of Veterinary Medicine, which opened last spring, allows students to do that and much more. “We wanted a simulation lab that would support our curriculum and something that would also support extracurricular learning,” says Nicholas Frank, DVM, PhD, DACVIM, associate dean of academic affairs for Cummings School of Veterinary Medicine at Tufts University in North Grafton, Massachusetts.
“Many schools have state-of-the-art simulation labs, but for many, it’s a spare space somewhere in the school that many students don’t take advantage of,” says Emily McCobb, DVM, MS, DACVAA, clinical associate professor and director of the Luke and Lily Lerner Spay/Neuter Clinic at the veterinary school. “In many schools, teachers and assistants are trying to balance the learning needs of their students within confined space limitations.”
The simulation lab at Cummings isn’t limited on space, which allows for extended hours. It is in a 3,000-square-foot area and is open 24/7 for students to practice on simulators with teachers, assistants, and peers as well as on their own.
School Needed to Bring Its Simulators into the Light
Leaders and faculty at the school several years ago recognized the need to modernize its simulators program. Frank says low-fidelity simulations are perfect for students just beginning, but he says technology in high-fidelity simulators started advancing rapidly about five years ago. While the school had some high-fidelity simulators, they felt they needed to upgrade the space and the program.
A view inside the newly renovated 3,000-square-foot Joseph Kelley, DVM, Simulation Laboratory at Tufts University Cummings School of Veterinary Medicine.
“Many schools have state of the art simulation labs, but for many, it’s a spare space somewhere in the school that many students don’t take advantage of. In many schools, teachers and assistants are trying to balance the learning needs of their students within confined space limitations.”
—Emily McCobb, DVM, MS, DACVAA
The school had also been successfully moving from practicing medicine on live animals to simulators. In the past few years, many organizations and veterinary schools have advocated to do more simulator surgeries, rather than using shelter animals, which are then either returned to the shelters or euthanized. “Using high-fidelity simulators is how we’ve evolved to now, only doing live animal surgeries after students have learned on simulators,” says Frank.
The former simulation lab was in a dimly lit space in the basement.
“It just wasn’t the best space,” says Bethany Karpowitz, a third-year student at Cummings.
Joseph Kelley, DVM, was a mentor to Cummings School alumni and gave a $5 million gift in his own memory. That, combined with other donations, allowed the construction of the simulation lab. The gifts also allowed the school to purchase $750,000 in simulators and create a $2 million endowment for the lab’s ongoing operation.
When Karpowitz returned to school for the Spring 2022 semester and saw the new simulation lab, she says she was surprised and excited to expand her studies there. “It is so brightly lit, and everything is fresh and new,” says Karpowitz. Parts of the lab are built to stay in place, but much of the lab’s tables and equipment roll and can be moved so instructors can configure the space in the best way for the lab that is scheduled.
The lab includes space for students to practice on the simulators, as well as space for producing some of the simulators in-house. Joe Popowski, a longtime teaching technician, creates low-fidelity models for students. Michael Karlin, DVM, DACVS, assistant professor of small animal surgery, designs high-fidelity 3D-printed simulators.
“The low-fidelity models basically look like a cylinder with various layers of coverings on it that simulate the skin and tissues,” says 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 only see the undraped section where they make the incision.”
The 3D models can be printed to simulate clinical problems such as limb deformities and abnormal vasculature.
A life-like simulator, named Robo Jerry, is connected to a computer and can simulate a crisis. Instructors can program the crisis and the program will report on the dog’s condition. 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.
How the Simulation Lab Benefits Students by Year
The idea behind the simulation lab was to create a clinical space that would be beneficial for all students. Ariana Hinckley-Boltax, DVM, is assistant professor of clinical skills. She says first- and second-year students learn “anything a veterinarian does with their hands,” which includes how to dress in a gown and gloves in a sterile environment, hold instruments, draw blood, place IV catheters, stitch using a variety of sutures, give a general examination, perform CPR, and conduct an ultrasound.
3D-printed models can be used to simulate real-world clinical cases that students can learn from.
“The new simulation lab creates the experience most see in the clinical space,” says Hinckley-Boltax. “The tables, lighting, and everything mimics a fully functioning clinic.”
McCobb notes some of the experiences first-year students have in the simulation lab are not unlike what some have seen if they have worked in a veterinary office. “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,” says McCobb.
One of the dedicated areas of the lab is for learning CPR skills. First-year students use low-fidelity models to learn basic life support skills such as establishing an airway and starting chest compressions.
Once students advance to the second year, they can practice on high-fidelity simulators such as Robo Jerry. Robo Jerry can be put through many crises and still come out OK, since he isn’t a real dog. Instructors set up the model and computer program and have the students respond as they would in a clinical setting to a real emergency. “When they get out into the clinics, they have to make real decisions,” says Mike Santasieri, CVT, LVT, the new simulation lab manager. “Robo Jerry gives them the freedom to practice making clinical decisions and makes the process less stressful when it is real.”
Another simulator, K9 Diesel, allows students to place IVs and catheters. “Students can monitor all vitals with changes in response to what they do,” says Santasieri. “We can put limbs on it with wounds and can simulate tracking and stopping bleeding.” Santasieri says K9 Diesel looks and weighs the same as a real dog.
The most advanced model is a canine SynDaver, which is a dog that simulates real surgery. SynDaver simulates things that happen in real surgeries, including blood and hemorrhaging. Frank says this model is for advanced students to use to practice surgery skills. However, they must go through all the steps from low- to high-fidelity models and complete those steps satisfactorily. Also, they must also agree to teach first-year students on suture lines and other basic skills.
Santasieri says students may also learn through observing students performing procedures as there are attached rooms with windows that allow for observation. Also, there are cameras and monitors placed in the simulation lab so students may go back and review their procedures.
The simulation lab is designed to mimic a real clinical setting.
“The new simulation lab creates the experience most see in the clinical space. The tables, lighting and everything mimics a full functioning clinic.”
—Ariana Hinckley-Boltax, DVM
All second-year students are required to perform a spay/neuter on a high-fidelity simulator before ending the year. One thing McCobb says she has seen is the lab simulates the clinical setting so well that students are able to use the verbiage used in the clinical setting. “By the time they get to the clinic they can understand some of the language we use there as it is not common and they may not remember it just from their studies,” McCobb says.
In the third year, students work in the spay/neuter clinic. McCobb says in addition to the high-tech simulators and clinical feel of the lab, the additional beauty is that the sim lab is right next door to the spay/neuter clinic. By the fall of their third year, students are working in the clinic and must complete a live animal spay. “Students are encouraged as much as they need to go back into the simulation lab and practice,” says McCobb. “They are right next door, so it is very convenient and creates a seamless process to go from simulation to a live animal clinic.”
Karpowitz helped form an extracurricular peer group that practiced in the simulation lab last year. Key cards allow students to access the simulation lab and the attached learning library, which has a wealth of materials students can use for research. “It’s really nice to have access anytime,” says Karpowitz. “This year, I had to place a catheter in a live dog, and I did it successfully because I was able to go to the sim lab and practice on my own time. It was something I hadn’t learned since the first year, so it was good to go back and review. It made me feel much more prepared and comfortable.”
Hinckley-Boltax says the suturing models are usually the most popular among students to practice on, followed by the catheter model, which allows students to practice placing and taping the catheter in place.
There are also many other learning models in the lab such as cardiology and anesthesia.
McCobb says she feels the simulation clinic is already helping advance students in their learning. “The students who have been using the simulation lab are performing at a very high level compared to previous years,” says McCobb. “They are more proficient. It’s improving the experience for the students and it’s more ethical for the patients.”
The teaching staff has many ideas on how to expand on what the simulation lab is doing including expanding the learning library and creating continuing education for both professionals within the university and veterinarians in the community. “There are many ways that this lab can be used,” says McCobb. “From our students on their first day to continuing education for the veterinary community, it’s pretty much limitless.”
Photos courtesy of Tufts University