by Marcia Hill Gossard '99, '04
(right) Nick Larson (’18 DVM) and Drew Fleischman (’19 DVM) use the endoscope to grab a button inside the digestive model. Models like these give students the opportunity to practice their medical skills.
Nick Larson gently guides a long flexible line with a light on the end into a model made of soft latex tubing in search for a “foreign body.” The light helps him see his way. Called an endoscope, the device is used to look inside a patient’s body to examine the esophagus, stomach, intestines, and other internal organs. A video image is projected on a screen so they can see where they are going and other students in the room can see what is happening inside the patient.
In the WSU Clinical Simulation Center, veterinary students use medical models and sophisticated equipment, like the endoscope, to practice their diagnostic and treatment skills before they work with live patients. The endoscope model recreates a patient’s intestinal tract using latex tubing. At the end of the tubing is a hollow ball, which creates a “stomach.” Students learn to navigate through the intestines, reach the stomach, and use a grasper that runs through the endoscope to retrieve items such as a small button.
The first time Larson and his other classmates tried to get the button, it took 45 minutes.
“It takes some practice to know where you are in a patient’s body, and how to turn to make sure you get to the right place,” says Dr. Julie Cary, director of the center. “Students may get frustrated, but then they can also start to see that they are getting better the more they practice.”
The endoscope, used exclusively for training veterinary students, was donated by Jim and Lisa King, WSU graduates and friends of the college.
“Having the support of donors is incredible,” says Larson. “I find it exciting and humbling to know that there are individuals who are choosing to invest in us and our education.”
From Sutures to the Emergency Room
Students Liz Soler (’18 DVM), Nick Larson, and Shelby Turnbull (’18 DVM) watch the endoscope procedure on the screen.
Veterinary students start in the Clinical Simulation Center on the very first day of their first semester in a surgery class designed to give them the skills and the confidence to do basic surgical techniques, such as closing skin incisions when they mentor with a veterinarian later in their education. All students are encouraged to come to the open lab, now in its sixth year, where they can practice the specific skills they would like to improve. The peer taught lab is run by veterinary teaching assistants. If a student needs practice with basic sutures, or has mastered that skill and is ready to performing entire surgical procedures, the lab has options for students at all skill levels.
“There is no judging student competence,” says Cary. “It is a safe space where students can come, practice, make mistakes, and learn from those mistakes.”
“Jerry,” one of the canine models, has a speaker inside so students can practice listening for heart and lung sounds. Careful listening and developing fine-tuned listening skills is very important, particularly since the animals can’t speak for themselves. Students practice listening and then interpret what the sounds could mean, what tests to perform, and treatment to recommend.
“One way we diagnose as veterinarians is by very carefully listening to the heart and lungs in many places,” says Cary. “Arrhythmias, murmurs, pneumonia, and asthma all have different sounds.”
In the technical simulation room, or “Oz Room” as Dr. Cary calls it, they simulate operating room and emergency room situations using an anesthesia team, surgical team, and code team (cardiac life support). On the video screen, using a model developed by Dr. Robert Keegan, a graphic eyeball blinks when the “mock” patient is wide awake. If it is still blinking after the student has given anesthesia, the students know that the patient is not all the way under. The pupil dilates based on what is happening in the room, and then students try to figure out what is causing the reaction in the patient. Blood pressure readings can also change so a student may see a sudden drop in the patient’s blood pressure and then they must decide how to treat, what to administer, and at what dose.
“This is what you have to practice before doing it on a live animal so that it is second nature,” says Larson.
Besides honing their technical skills, students also get to see how they perform together as a team, and learn how they could have communicated better, especially when faced with an emergency.
“The quality of the teamwork affects the outcomes for patients and clients,” says Cary.
Cows and Horses
In the barn side of the simulation center are Gladys and Ferdinand, a cow and her calf ready to be born. Gladys, the 31st model of her kind, is life-sized.
“Having the full-sized model the student can better understand their relative size to the cow”, says Cary.
Ferdinand is made from a heavy pliable rubber-like material, so when he gets wet it feels like a real calf being born. Students learn to practice pulling a calf out in different positions, much like they would experience on live animals. Students learn to feel for a leg, where to put the straps to pull out the calf, and how much force to use. They may learn if they need to stand on a stool and how to position themselves. For some students, just being next to something this big and figuring out how position themselves can make a difference.
“Assisting with a difficult birth is something the most students don’t get exposure to,” says Cary. “If you never have the experience, you don’t get good at it. The model lets them have that experience.”
Standing next to Gladys is Whiskey, the horse. Whiskey has all parts of a horse’s digestive tract so students can practice exams for colic, a common illness. In the center, they can create in the model symptoms for different kinds of colic so students learn how to accurately diagnose them. It is important to be able to tell the common kinds of colic from the dangerous kinds so a horse can get care quickly. Students also learn where to stand so they are less likely to get kicked.
“It is nice to learn these things prior to standing in front of a client,” says Cary with a smile.
Practice Makes Perfect
Confidence, says Larson, is what practice in the center’s labs gives him and other students. Confidence not only helps with the procedure, but also in how to talk to a client who may be feeling upset or distressed.
“Until you have the opportunity to try something new, you always have that self-doubt,” says Larson. “Being able to practice numerous procedures gives me the confidence that I can tackle anything down the road in my career.”
Simulations improve techniques and give students feedback as to how they could do better the next time. It might be how team members communicate with each other during an emergency, and what they could do to improve communication to better help future patients. Or it could be something as simple as if the students had lowered the table, they could have given more effective chest compressions to the patient.
“We reinforce with models so they see the common things they are going to see in their practice,” says Cary. “A lot of times it is the confidence that gets you through the whole thing.”