Fourth-year Veterinary Students Research Articles

Evaluation of Peer Simulations Utilizing Student Generated Case Studies with Pre-clinical Veterinary Students

A novel student-driven model of peer simulations using reverse case studies was developed during the COVID-19 pandemic to provide virtual instruction to fourth-year clinical veterinary students. Focus groups suggested that, while this teaching method could not replace hands-on clinical experience, it could be a valuable tool to clinically prepare students during their pre-clinical curriculum. The primary aim of this study was to determine whether this teaching method enhanced earlier curricular student comfort with clinical reasoning, communication, and peer role play as measured by pre- and post-surveys. A secondary aim was to evaluate clinical reasoning ability using the validated Modified Lasater Clinical Judgment Rubric (MCJR). Eighteen pre-clinical veterinary students participated in a 1-week course where they designed and presented clinical cases and participated through virtual role play as clients, clinicians, and observers. Our results demonstrated that students’ comfort in clinical reasoning and peer role play significantly improved ( p < .001 and p = .003, respectively) after participating in this activity. The role perceived to be the most helpful at developing clinical reasoning and communication skills was clinician, followed by client then observer. Results from the MCJR found significant discrepancies between facilitator scoring and student self- and peer-assessment ( p < .001). Common themes emerged including the benefits of engaging in self-reflection, peer-to-peer learning, experiencing case ownership and autonomy, and practicing communication and clinical reasoning skills. This teaching method provides a valuable alternative to client simulators and suggests having students create a case as a client offers a unique educational opportunity.

Geometric, landmark-guided technique reduces tissue trauma, surgery time, and subjective difficulty for canine peripheral lymphadenectomies: an educational crossover study.

To compare the effect of a geometric, landmark-guided lymphadenectomy (LL) approach to peripheral lymph nodes (LNs) on successful LN identification, surgical time, tissue trauma, and ease of LN identification compared to standard lymphadenectomy (SL) and methylene blue-guided lymphadenectomy (MBL). 18 adult, mixed-breed canine cadavers operated on by 7 veterinarians and 5 fourth-year veterinary students between July 23 and October 12, 2022. Participants were provided standardized, publicly available materials regarding the anatomy and surgical techniques for SL of 3 peripheral lymphocentrums: superficial cervical, axillary (ALN), and superficial inguinal (SILN). Participants performed the 3 SLs unilaterally on canine cadavers. Thereafter, they were randomly assigned to 2 crossover groups: MBL and LL. All dissections were separated by at least 2 weeks for each participant. Primary outcome measures included successful LN identification, surgical time, tissue trauma scores, and subjective difficulty. Successful LN identification was highest with LL (86%) compared to SL (69%) and MBL (67%). Subjective difficulty scores were reduced with LL for SILN dissections. Tissue trauma scores were reduced when using LL for ALN and SILN compared to MBL and SL. Time to LN identification was reduced for ALN with LL. No significant differences were observed between MBL and SL, or for the superficial cervical dissections. Peripheral lymphadenectomies are time consuming and difficult for veterinarians in early stages of surgical training. Little surgical guidance is provided within current literature. Geometric, landmark-guided lymphadenectomies may improve LN identification success and reduce surgical time, tissue trauma, and procedure difficulty, which could encourage their clinical application.

Evaluation of Student Engagement, Communication, and Collaboration during Online Group Work: Experiences of Fourth Year Veterinary Medicine Students.

Accelerated by the COVID-19 pandemic, online teaching has become widely established in higher education in recent years. However, little is known about the influence of the online environment on collaborative student activities which are an integral part of veterinary education. This study explored engagement, collaboration, and communication among fourth-year veterinary students working in groups on online case-based learning (CBL) activities. Data were collected by questionnaire (93/135) and anonymous peer assessment (98/135) at the end of the trimester. While most students (67%) enjoyed group work and 75% considered it of benefit to their learning, the results indicated that the students' interaction was mainly limited to task management and collating individual answers on shared documents. Rather than meeting online, students communicated by chat and messenger apps. Agreement of roles, rules, and the group contract were largely treated as box-ticking exercises. The conflict was the only factor that affected group work satisfaction and was largely avoided rather than addressed. Interestingly lack of student engagement in group work was not related to overall academic performance and had no impact on their end-of-term exam results. This study highlights high student satisfaction and engagement with online group CBL activities even when collaboration and communication was limited. Achieving higher levels of collaborative learning involving co-regulation of learning and metacognitive processing of learning content may require more specific, formal training in relevant skill sets from an early stage of the veterinary curriculum.

Examination of Motivational Influences on Clinical-Year Veterinary Students' Career Decisions.

The purpose of this study was to identify motivations for fourth-year veterinary students to choose future career paths based on post-graduation employment or post-graduation education. Approximately 500 students from four institutions were invited to participate in an online survey. Surveys were based on the cognitive evaluation theory, a minitheory within the self-determination macrotheory framework developed by Deci and Ryan. Intrinsic motivational factors were categorized by autonomy, competence, and relatedness, and extrinsic motivators were categorized by environmental and interpersonal factors. Students pursuing post-graduation education have intrinsic motivators that aligned with competence and were extrinsically motivated by a mentor, while students interested in post-graduation employment had intrinsic motivators that were more focused on autonomy with extrinsic motivational influences of debt/finances and geographic location.

Evaluating third- and fourth-year veterinary students' communication skills knowledge and performance at Colorado State University.

To assess the impact of a communication program on a cohort of veterinary students' knowledge and performance of communication skills. Class cohort of veterinary students at Colorado State University. Year 3 students' knowledge of communication skills was evaluated using quizzes, administered before and after the fall 2016 and spring 2017 Clinical Communication Skills-I and II junior practicum. In year 4, student performance of 22 Calgary-Cambridge Guide communication skills was assessed by coding video-recordings of student-client interactions collected during their second and fourth weeks of the Community Practice rotation in the summer and fall of 2017 and spring of 2018. The impact of training, association with demographic factors, and correlation between knowledge and performance of communication skills were investigated. In year 3, 136 students completed both fall and spring quizzes; in year 4, 65 week-2 and 29 week-4 appointments were video-recorded during Community Practice rotation. Students' knowledge assessed via quizzes containing skill spotting and skill demonstrating questions increased significantly after the fall and spring junior practicums; however, knowledge of communication skills was not associated with performance during year 4 Community Practice rotations. Communication skills most frequently demonstrated by students during the fourth year Community Practice rotation were open-ended questions, closed-ended questions, empathy toward the client and patient, providing "chunks" of information, and signposting. Students received high quality scores for non-verbal behaviors and logical clinical interview structure. Results suggest that experiential learning techniques, including a flipped classroom approach, role-play, and communication laboratories contributed to increased student knowledge of communication skills.

Bull sperm morphology assessment varied by evaluator

Assessment of sperm morphology is an important part of bull breeding soundness evaluation (BBSE). Whereas the effects ofevaluator experience and evaluation method on the sperm morphology estimation were assessed in other species, no such studywas conducted for bulls. Our objectives were to assess the effects of evaluator experience and number of sperm assessed on BBSEoutcomes. A single eosin-nigrosin sperm morphology slide from individual semen samples, collected from 35 yearling bullswas used. In Experiment I, 6 individuals (3 board-certified theriogenologists [DACT] and 3 fourth-year veterinary students [VS])evaluated 100 sperm from 35 slides twice (at least 1 week between evaluations). In Experiment 2, 3 DACT evaluated 100, 200,and 400 sperm from the same 5 sperm morphology slides to determine if assessing a higher number of sperm would increase theagreement of morphologic characteristics. In Experiment 1, there was a difference (p < 0.0001) in the percent of sperm classifiedas morphologically normal between evaluator types (VS versus DACT). Furthermore, variation among evaluators affected spermmorphology assessments and bull breeding soundness evaluation classifications. Whereas the time needed to evaluate slides increased(p = 0.96) with increasing number of sperm assessed, there was no effect (Experiment 2) of number of sperm evaluatedon percent normal sperm, indicating that evaluating more than 100 sperm may not be justifiable. Further investigation on slidepreparation, microscope use, assessor experience, and continuing education/training is important to ensure the repeatability andvalidity of evaluating bovine sperm morphology.

Characteristics of and comparisons between US fourth-year veterinary students graduating with and without educational debt from 2001 through 2020.

To characterize and compare fourth-year students of US veterinary schools graduating with and without related educational debt (ie, DVM debt) from 2001 through 2020. 45,756 fourth-year veterinary students who participated in the annual AVMA Senior Survey from 2001 through 2020. Survey data were summarized for variables hypothesized to be associated with DVM debt. Multivariable modeling was used to investigate associations between these variables and the likelihood of graduating with DVM debt. Mean DVM debt increased fairly steadily from $56,824 in 2001 (n = 1,587) to $157,146 in 2020 (2,859). Of 45,756 students, 6,129 (13.4%) had no DVM debt. Attending Tuskegee University and having children (both men and women) were associated with an increased likelihood of DVM debt. Attending certain other veterinary schools and more recent survey year were associated with a decreased likelihood. For 2020, the likelihood of DVM debt decreased with increasing percentage of tuition paid by family and increased with increasing percentage of tuition paid by educational loans, being a woman with children, and increasing total cost of attendance. No association was found with state cost of living index or per capita income. Results suggested a growing rift between US veterinary students who cannot afford tuition and fees without accumulating financially concerning levels of debt and those who have the financial ability or family situation to fully fund veterinary school. Efforts should be undertaken to recruit across socioeconomic statuses and provide meaningful scholarships to students with greatest financial needs to support diversity, equity, and inclusion in veterinary medicine.

Self-Efficacy and Student Satisfaction in a Clinical-Year Diagnostic Imaging Course Using an Online Instruction Format.

Accurate interpretation of radiographic images is critical to diagnosing clinical patients. Remote instruction in radiology has become more common at veterinary colleges as academic institutions struggle to fill open veterinary radiologist positions and as a result of the COVID-19 pandemic. This study sought to gather the feedback of fourth-year veterinary students via pre- and post-study surveys (n = 45) and focus groups (n = 7) about a newly implemented 2-week long radiology rotation. Ninety-eight percent of students reported having taken an online course before, and on both pre- and post-study surveys, students commonly reported feeling interested, determined, and attentive. On average, students reported that they were neither more nor less engaged than they would have been in an in-person course and that they understood the material neither better nor worse than they would have in an in-person course. Students reported that the key to their success was primarily hard work; secondarily, instructor availability and student ability were important. Students did not rate luck as having much influence on their success. Although diagnostic imaging can be a challenging subject to master, students effectively learned this subject through online instruction. They provided feedback for the course's continued improvement; their comments centered around improved interactivity, including providing automated quiz questions' answers and increased instructor availability. Data collected in this study will help to guide further development of the radiology course.

Transforming a Didactic Lecture into a Student-Centered Active Learning Exercise—Teaching Equine Diarrhea to Fourth-Year Veterinary Students

Problem-solving abilities, creative and critical thinking, communication skills, and teamwork are now recognized as fundamental determinants of professional success, especially in vocational professions, such as veterinary science. Tertiary education is now obliged to provide opportunities for students to become proficient in these qualities. With this in mind, the principal author, an equine science senior lecturer, attempted to increase student engagement by developing a new active learning, student-centered one-hour teaching episode on ‘equine diarrhea’, to replace the traditional didactic lecture format. The aim of the study, therefore, was to share the principal author’s journey in the development and implementation of this active learning episode and to explain why it represents a simple but effective method of promoting student engagement. In addition, the adaptation of this method into an online teaching and learning format is briefly discussed. The effectiveness of this active learning method is also explored by comparing it with the traditional didactic method of delivery. Students in the active learning class reported that the learning activity had enhanced their skills in clinical reasoning, problem-solving, and communication. They also described themselves as active participants in the learning process. Students in the traditional didactic class reported that they were satisfied with the time allocated to the lecture, felt that the lecture was well organized and managed, and subsequently felt adequately prepared to answer conventional examination questions relating to equine diarrhea. Other issues, such as student resistance to changes in teaching formats, the effectiveness of group work or teamwork, levels of student confidence within an active learning environment, and the importance of high-quality facilitation during active learning activities, are also discussed in this paper. Although the active learning method described is not novel, the authors hope that fellow educators, across any tertiary discipline, might find that the method described represents a quick and simple method of transforming a single didactic lecture into an enjoyable and engaging learning activity.

Assessing the Impact of a Virtual Shelter Medicine Rotation on Veterinary Students' Knowledge, Skills, and Attitudes Regarding Access to Veterinary Care.

Strong bonds commonly form between companion animals and people of all socio-demographic backgrounds, yet many pet owners face numerous barriers to accessing veterinary care for their companion animals. For example, they may have difficulties paying for care; they may lack veterinary practices in their community; and they may experience language barriers that impede their ability to utilize veterinary services. Various strategies exist that can help veterinarians address the diverse needs of pet owners in their communities, but these techniques are not commonly covered in the veterinary school curriculum. This study explored how including in-depth, purposefully curated information about access to veterinary care issues within a required shelter medicine rotation impacted fourth-year veterinary students' knowledge, skills, and attitudes regarding the problems clients commonly face when seeking access to veterinary care. Students participated either in a control group of a virtual, four-week rotation delivered via Zoom meetings and self-study, or in an experimental group that additionally completed an interactive online learning module. The online module heavily featured issues surrounding access to veterinary care. Irrespective of which version of the rotation students enrolled, their opinions grew more favorable from pretest to post-test regarding the role of not-for-profit veterinary clinics in communities, as did their expectations that veterinarians should provide affordable treatment options. Additionally, students in the experimental group demonstrated from pretest to post-test increased awareness of the potential for implicit bias toward pet owners within veterinary practice and showed a reduction in their tendency to be judgmental of veterinary clients. By the end of the study, students in the experimental group also expressed greater confidence in their ability to offer incremental care treatment options to veterinary clients. These findings suggest that providing content that focuses on increasing access to veterinary care enhances students' awareness of the need to offer a variety of treatment and payment options to clients. Findings from this study can inform curriculum design in veterinary schools and continuing education programs for veterinary professionals.

Influence of musical preferences and intraoperative questions on suturing speed.

To determine the effect of music and surgeon-directed questions on suturing speed. Randomized observational study. Fifty-five faculty veterinarians, residents, interns, and fourth-year veterinary students. Experience, gender, and favorable and unfavorable music choices were self-declared by participants. Each person performed four timed suture trials, which required them to complete a simple 10cm continuous suture pattern on a model. The initial trial served as practice and did not include music or questions. The order of the three remaining trials was randomized, and consisted of one trial each with favorable music, unfavorable music, and required the participant to answer 2 questions. Trial duration was compared using a mixed effects linear model. Influence of gender and experience on participants' categorical responses to 2 different questions was evaluated using a Pearson χ2 test and Fisher's exact test, respectively. Stratified analysis was used to evaluate further the effect of experience and gender. Question trials were on average 8.1s longer than favorable music trials (P=.008), with no notable difference found between unfavorable and favorable music or unfavorable music and question trials. Experience (P=.021) and gender (P=.033) influenced participants' response to question 1 but not question 2 (P=.267 and P =.839, respectively). Listening to favorable music, rather than answering questions, may result in decreased closure times. This influence was greater for less experienced individuals and less experienced male veterinarians and veterinary students. The absence of questions may increase suturing speed, particularly for minimally experienced surgeons or when instruction is taking place in a surgical laboratory setting.

Implementation of a Fine Needle Aspirate Simulation Model.

Being able to appropriately perform fine needle aspiration (FNA) collecting techniques and sample preparation is essential in obtaining a diagnostic sample, which is a critical skill for veterinary practitioners. Collection and preparation of cytologic samples are skills gained through practice. Experience leads to refinement of technique and improved diagnostic quality. Using live patients for mass skills training is not feasible; therefore, an aspiration simulation model and laboratory session was developed to reinforce physical exam skills, appropriate selection of sample collection supplies, and collection technique. Materials for the models include Ping-Pong balls, silicone, instant vanilla pudding mix, water, and stuffed animals. The laboratory session allows veterinary students to practice lesion identification, isolation, aspiration, and successful preparation. Subsequent submission of the collected sample involves being able to expel and spread the sample on a slide and proper labeling. While the simulation experience was initially developed for a short course with 12 students, it has recently been incorporated into the required clinical pathology clinical year rotation for up to 100 fourth-year veterinary students. The model is inexpensive and efficient and allows for technique development and immediate instructor assessment and feedback.

The Use of Adaptive Learning Technology to Enhance Learning in Clinical Veterinary Dermatology.

Clinical teaching in veterinary medicine is challenging for both educators and students. There is an increasing interest in the use of technology-based techniques using adaptive learning to provide students with additional learning experiences. Few studies have evaluated the use of this technique in veterinary medical education. We hypothesized that students with access to adaptive learning modules during dermatology rotation would have significantly higher dermatology test scores compared to students who did not have access to the adaptive learning modules on the same rotation. Incoming third and fourth-year veterinary students to the dermatology rotation, who agreed to participate, were randomly assigned to treatment (provided access to 10 modules using adaptive technology during the rotation) or control group (provided no access to the modules). Study participants completed a pretest two weeks before the rotation start date and a post-test near the rotation end date and a questionnaire to assess students' learning experience using adaptive learning modules. Students in the treatment group scored significantly higher on the posttest (p = .019) compared to students in the control group, with an effect size of d = 0.83. Students in both groups scored significantly higher at post-test (p < .001; d = 1.52 treatment and p = .002; d = 0.74 control) when compared to their pretest. This study shows that the tested adaptive learning platform may be an effective method to augment clinical teaching in veterinary dermatology. This study also indicates that veterinary students perceive the use of adaptive learning technology as beneficial for their education.

Comparison of Hemorrhagic Complications with Double-ligated versus Auto-ligated Feline Ovarian Pedicles by Fourth-Year Veterinary Students.

The objective of this article is to compare the occurrence of hemorrhagic complications in student-performed feline ovarian pedicle ligations using the traditional suture pedicle double-ligation (PDL) to the suture-less auto-ligation (AL) techniques, and to describe the stepwise method of teaching the AL technique to students. A total of 287 cats underwent an ovariohysterectomy (OHE) performed by a fourth-year veterinary student trained by veterinary faculty to perform the AL technique beginning with a low-fidelity model and progressing to live patient surgeries. Students performed the AL and PDL techniques on 146 and 141 cats respectively. Hemorrhagic complications occurred in 4 of 146 cats (2.7%) in the AL group and 8 of 141 (5.7%) in the PDL group and were not found to be significantly different (p = 0.2496). This article demonstrates that novice surgeons can safely perform the AL technique on feline ovarian pedicles without significantly increasing complications compared to the traditionally taught method when a stepwise training program is implemented. Additionally, this technique has been shown to be safe, effective, and more efficient when performed by experienced veterinary surgeons.1 Veterinary institutions should consider including the AL technique in their core curricula as a standard method for feline ovarian pedicle ligation. Doing so will facilitate the development of more proficient entry-level practitioners who are better able to serve their patients, clients, employers, humane societies, and their communities by using a more efficient and safe feline ovariohysterectomy technique.

Development and assessment of a formal learning module to educate veterinary students in an intensive care unit about transfusion reactions.

To develop and assess the instructional efficacy of an online learning module on transfusion reactions in small animals and to evaluate participants' satisfaction of the module. Randomized controlled trial. University teaching hospital. A total of 55, fourth-year veterinary students, 27 in a treatment group that received the learning module plus standard rotation training and 28 in a control group (no module) who received only standard training INTERVENTIONS: Students received a pretest on transfusion reactions followed by administration of a transfusion reaction learning module covering recognition, treatment, prevention, case examples, and self-assessment questions for 6 common transfusion reactions. Students also received a module satisfaction survey, a post-test at 2weeks post-module, and a retention test at 6weeks post-module. Previous transfusion medicine exposure did not affect pretest scores and there was no difference in pretest scores between groups. The module group scored higher on the post-test (P< 0.001) and retention test (P= 0.002) than the control group. Mean post-test scores were 74.4% and 57.7% and mean retention test scores were 80.6% and 56.5% for the module and control groups, respectively. The module group scored higher on posttest and retention questions involving reaction recognition (P< 0.001). Students were overall very satisfied with the module with an average score of 4.8 (1-5). A transfusion reaction instructional module can be delivered successfully to veterinary students on an ICU-based clinical rotation. Students taking the module scored significantly better on post-assessments up to 6weeks after module administration as compared to students receiving only conventional clinical rotation training.

Cross-Sectional Assessment of the Emotional Intelligence of Fourth-Year Veterinary Students and Veterinary House Officers in a Teaching Hospital.

Emotional intelligence (EI) is the recognition and management of emotions. This skill set is important to work relationships and professional success. In this cross-sectional, observational study, we investigated EI scores of 4th-year veterinary students, interns, and residents in a teaching hospital, using a psychometric tool with professional population norms. Participants' EI scores were compared with professional norms and between the sample groups. Scores were examined on the basis of demographics and residency program type. Twenty-four 4th-year students and 43 interns and residents completed the survey. Total, composite, and subscale scores for all groups were lower than professional means. We noted no statistically significant differences in EI scores between training levels, but evaluation of effect sizes showed a medium negative effect of higher training levels on Self-Perception Composite, Self-Regard, Emotional Expression, Interpersonal Composite, Flexibility, and Optimism and a medium positive effect of higher training levels on Impulse Control. Medium effects for residency type were found for Stress Tolerance, Flexibility, and Stress Management, with higher scores for residencies with heavy inpatient loads. Medium effects for residency type were found on Flexibility scores, with higher scores for residents in disciplines with a perceived high stress level. We found that baseline EI scores of 4th-year veterinary students, interns, and residents at a teaching hospital were similar to, but uniformly lower than, those of other professionals and did not increase with training level. These results may be used to build on strengths and address weaknesses associated with EI of students and house officers at this institution.

Strategies to Improve Case Outcome When Referral Is Not Affordable.

We conducted a survey-based study to determine whether on-site consultations and cost-effective protocols are beneficial to general practitioners handling challenging small animal internal medicine patients when owners cannot afford referral and whether fourth-year veterinary students benefit from training in this area. Fifteen general practices were visited over 12 months by a board-certified internist and students. On-site consultations for patients belonging to owners who could not afford referral were conducted by the internist. Students and general practitioners completed pre- and post-participation surveys. Students' surveys contained questions about comfort level with complicated cases on a budget and knowledge gained from, and perception of, the on-site consultations and protocol development. Practitioners' surveys contained questions about comfort level and experience with complicated internal medicine cases, the benefit of the consultations, and the cost-effective protocols, which were compiled into a booklet for practitioners. All students and practices completed the pre-survey, and 56 of 60 (93.3%) of the students and 13 of 15 (86.7%) of the practices completed the post-survey. Approximately 68% of students believed their comfort level with budget-limited cases improved and that they benefited from participation in the consultations and protocol development. Similarly, most general practitioners believed these strategies were highly beneficial. The cost of veterinary care, especially referral medicine, is unaffordable for many owners. Veterinary students should be exposed to these challenges and trained in cost-effective approaches. Similarly, general practitioners may be able to more successfully and efficiently diagnose and treat challenging internal medicine cases using the proposed strategies when owners decline referral.

Full-Time Employment or Post-Graduate Education: A Means-Ends Investigation of Fourth-Year Veterinary Students.

The purpose of this article is to identify the motivations for fourth-year veterinary students to pursue either full-time employment or post-graduate education. Twenty-one fourth-year veterinary students were interviewed using a means-ends investigation style. Interviews were analyzed using a qualitative method in the context of the self-determination theory pillars of intrinsic motivation (autonomy, competence, and relatedness). Students interested in full-time employment had more statements that were categorized as demonstrating an interest in autonomy. Students who were interested in post-graduate education had more statements that were categorized as demonstrating an interest in developing competence. Both groups of students indicated that relatedness was important. Understanding the beliefs and motivations that influence students' post-graduation career decisions is important in framing their decision-making process.

Mucous Membrane Color Assessment Variability of Veterinary Students Using Either Colorimetric or Word-Based Scales.

A colorimetric scale has the potential to be very useful as a training tool for students in veterinary training programs. The authors of this report hypothesized that clinically active, graduate level veterinary students would assess mucous membrane color with greater consistency using an image-based system than with traditional word-based techniques. Third- and fourth-year veterinary students were asked to evaluate 10 canine gingival mucosa images and rate them with either an image-based scale designed by the authors or a word-based system. Although the mean absolute deviations from the median values were greater for the word scale (0.22) than for the image scale (0.20) indicating increased variation, mixed model analysis did not demonstrate these differences were significant ( p = .120). Based on this data it is possible that prior image and word-based instruction made it easier for the students to differentiate mucous membrane colors, or that the majority of the students were multimodal learners rather than single-type learners, making previous instruction techniques effective regardless of whether they were visual or read/write based. The authors recommend that future investigators both evaluate previous student instruction and consider administering visual, auditory, read/write, kinesthetic (VARK) tests when investigating potential learning aids in veterinary medicine.

Evaluation of various hemostatic knot configurations performed by veterinary students.

OBJECTIVE To determine the most effective hemostatic knot configuration performed by veterinary students following a brief training session with an experienced surgeon and a subsequent deliberate self-training period. DESIGN Experiment. SAMPLE 24 fourth-year veterinary students with no previous surgical knot-tying experience. PROCEDURES In a 1-hour training session, an experienced surgeon showed veterinary students how to perform 5 hemostatic knot configurations (giant, slip, strangle, surgeon's, and transfixing), which they then practiced at home on a hemostasis simulator for 2 weeks. Thereafter, students performed each knot 4 times (twice each with monofilament and multifilament suture) on a hemostasis simulator. An experienced surgeon evaluated the correct execution of knots and measured their effectiveness by use of a manometer to measure vessel pressure distal to the ligature. Each student completed a questionnaire regarding their perceived learning and execution difficulty and sealing security for each knot. Responses were compared among knots and suture materials. RESULTS Overall, students considered the surgeon's knot the easiest to learn and the strangle knot the most difficult. The slipknot was also considered the easiest knot to perform, and the giant knot was considered the most difficult. The strangle knot was deemed the most effective in reducing vessel pressure distal to the ligature. CONCLUSIONS AND CLINICAL RELEVANCE The strangle knot was the most effective hemostatic knot in inexperienced hands, although veterinary students considered it more difficult to learn than other, perhaps more commonly taught, knots. Therefore, teaching of the strangle knot should be encouraged in veterinary schools.