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 Comparative studies of student performance:
humane teaching methods demonstrate educational efficacy when compared to harmful animal use in biomedical education.

Knight, Andrew; Balcombe, Jonathan; De Boo, Jasmijn. Animal Consultants International. Unpublished. Updated: 8 Jan. 2007. Please help to keep this resource up to date by emailing additions or updates.

 
The humane alternatives to harmful animal use in biomedical education have been designed by professional educators and scientists, and their educational efficacy is clearly demonstrated by the fact that nearly every comparative study has shown that students using humane alternatives perform at least as well as those trained via harmful animal use. At least 33 papers sourced from the biomedical and educational literature, covering all educational levels and disciplines, describe studies that have compared the ability of humane alternatives to impart knowledge or clinical or surgical skills. 39.4% (13/33) demonstrated that alternative students achieved superior learning outcomes, or achieved equivalent results more quickly, allowing time for additional learning. 51.5% (17/33) demonstrated equivalent educational efficacy, and only 9.1% (3/33) demonstrated inferior educational efficacy of humane alternatives. The design of one of the latter studies has been substantially criticized. 74 additional papers are also provided in which comparison with harmful animal use did not occur, demonstrating further educational efficacy, as well as staff time and cost savings and other important advantages of humane teaching methods.

CONTENTS

Papers demonstrating superior educational efficacy of humane alternatives (13)

Papers demonstrating equivalent educational efficacy of humane alternatives (17)

Papers demonstrating inferior educational efficacy of humane alternatives (3)

Other relevant papers (e.g., comparisons not involving harmful animal use) (74)

 

See also: Patronek GJ & Rauch A.Systematic review of comparative studies examining alternatives to the harmful use of animals in biomedical education. JAVMA 2007;230(1):37-43. Download from http://avmajournals.avma.org/doi/pdf/10.2460/javma.230.1.37 (fee: USD 10.00) or request.

Objective: To systematically review the published literature for controlled studies comparing learning outcomes of traditional methods that require the terminal use of animals (eg, dissection, live-animal surgery, and live-animal laboratory demonstrations) with outcomes obtained with alternative teaching methods.

Design: Systematic review.

Study Population: Controlled studies published between 1996 and 2004.

Procedures: PubMed was searched with the following keywords, used alone and in combination: educational alternatives, nonlethal teaching methods, veterinary alternatives, medical education, and nonterminal animal use. Cited references of retrieved reports were reviewed to identify additional reports. Reports were selected for review only if a comparison group was included.

Results: 17 studies that were randomized controlled trials or nonrandomized trials that included a comparison group were identified. Five involved veterinary students, 3 involved medical students, 6 involved university undergraduate students, and 3 involved high school biology students. Sample size ranged from 14 to 283 students. Eleven studies appeared to be randomized, parallel-group trials, 4 involved comparative groups to which participants were not randomly assigned or for which the randomization process was not clear, 1 was a 2-period crossover study, and 1 involved a retrospective review of grades. In all 17 studies reviewed, results associated with the alternative method of instruction were not significantly different from or superior to results associated with the conventional method.

Conclusions and Clinical Relevance: Although the number of controlled studies identified was small, the results seem to support more widespread adoption of alternative teaching methods in biomedical education.
 

Papers demonstrating superior educational efficacy of humane alternatives (13)

Abutarbush Sameeh M., Naylor Jonathan M., Parchoma Gale, D'Eon Marcel, Petrie Lyall & Carruthers Terry. Evaluation of traditional instruction versus a self-learning computer module in teaching veterinary students how to pass a nasogastric tube in the horse. Journal of Veterinary Medical Education 2006;33(3):447-54. Correspondence: sameeh75@hotmail.com.

Objective – To evaluate the effectiveness of a self-learning computer module (SLCM) versus traditional instruction in teaching how to pass a nasogastric tube (NG) in the horse.

Design – a double-blind, monocentric study.

Sample population – 52 third-year students in the DVM program were randomly assigned to two groups: traditional instruction (N = 25) or SLCM instruction (N = 27).

Procedure – Traditional instruction consisted of an instructor and live demonstration; SCLM students were given a CD-ROM each. Both sessions lasted one hour. The students were then united in one session to practice passing the NG tube. Their performance was videotaped and evaluated by two evaluators. Students were then given a multiple-choice knowledge quiz. One week later, a second demonstration of the same procedure by the two methods was administered, and students were allowed to choose either method of instruction. A Likert-scale questionnaire about their comfort, their confidence, and the appropriateness of the teaching method was given after the second demonstration. Data were analyzed by non-parametric tests. A focus-group study was conducted to determine students’ perception of each teaching method. Nine participants in the experiment volunteered for these focus-group sessions. The sessions were audiotaped and transcribed.

Results – Students in the SLCM group performed significantly better on the test of knowledge than traditionally instructed students. The questionnaire found significant perceived benefits to computer-based instruction, including a preference for the computer-based module, better learning, and greater preparedness. In hands-on skill, time to pass the NG tube on the successful attempt was significantly shorter in the SLCM group than in the traditionally instructed group. The data from focus-group sessions suggest that while participants expressed satisfaction with both modes of instruction, the SLCM group reported somewhat higher levels of confidence in their skills prior to performing the procedure. Whereas the traditional group reported a strong preference for continued live demonstrations of the procedure, the SLCM group stated that the computer-assisted module alone provided them with effective instruction.

Conclusion – computer-assisted learning is an acceptable and effective method of training students to pass an NG tube with potential welfare, proficiency, and knowledge advantages.

Fawver, A.L., C.E. Branch, L. Trentham, B.T. Robertson & S.D., Beckett. A comparison of interactive videodisc instruction with live animal laboratories. American Journal of Physiology 1990;259(Advances in Physiology Education 4):S11–14.

This study compared interactive videodisc-simulated laboratories with two types of traditional labs: a traditional general cardiovascular physiology participation lab and a traditional fibrillation/positive pressure ventilation demonstration lab. The two laboratory sections (a total of 85 first-year veterinary medical students) were divided into 12 lab groups of 3-4 students per lab section. These groups were randomly assigned to either a traditional live animal laboratory or an interactive videodisc-simulated laboratory to compare the effectiveness and efficiency of these methods in teaching physiology. A 22-item, multiple-choice/short answer test was given to all students after the laboratories. In both the participation and the demonstration laboratories, there were no significant differences between group test scores of the interactive videodisc groups and the live animal laboratory groups, but there were differences in time spent by both students and instructors. It was concluded that the interactive videodisc-simulated lab was as effective as the traditional live-animal labs and was more time efficient than the traditional participation lab.

Fowler, H.S. & E.J. Brosius. A research study on the values gained from dissection of animals in secondary school biology. Science Education 1968;52(2):55–7.

High school students who watched films of animal dissections (earthworm, crayfish, frog, perch) demonstrated greater factual knowledge of these animals than did students who performed dissections on them.

Griffon DJ, Cronin P, Kirby B, Cottrell DF. Evaluation of a hemostasis model for teaching ovariohysterectomy in veterinary surgery. Vet Surg 2000;29(4):309-16. Department of Veterinary Clinical Studies, Easter Bush Veterinary Centre and the School of Cognitive Science, The University of Edinburgh, Scotland.

OBJECTIVE: To evaluate the efficacy of a reusable plastic model mimicking the anatomy and hemodynamics of the canine female genital tract for teaching basic surgical skills and ovariohysterectomy. SAMPLE POPULATION: 40 veterinary students of the class of 1998. STUDY DESIGN: Prospective study. METHODS: Students' confidence level and experience in private practice was evaluated via questionnaire before training. Students in 2 groups performed an ovariohysterectomy on cadavers (group C, n = 20) or on the model (Group M, n = 20) for 2 hours. Students' psychomotor and basic surgical skills were objectively assessed by the following tests: ligation of a foam cylinder, passing a needle through the eyelets of an electronic suture board, and ligating latex tubing. Results were compared before and after training and within and between groups. The ability of students to perform an ovariohysterectomy in a live dog after training was compared between groups with a scoring system. RESULTS: Students in both groups had similar surgical experience and basic skills before training. The results of the psychomotor and basic surgical skills tests were better in group M after training than group C. The improvement of each student in performing these tasks also increased when students were trained with the model. Scores assigned to students performing an ovariohysterectomy in a live dog were higher in group M (31.45 +/- 1.15) than in group C (20.7 +/- 1.42). CONCLUSION: The model was more effective than cadavers in teaching basic surgical skills and ovariohysterectomy in dogs.

Henman, M.C., & G.D.H. Leach. An alternative method for pharmacology laboratory class instruction using biovideograph videotape recordings. British Journal of Pharmacology 1983;80:591P.

Undergraduate pharmacology students using biovideograph performed significantly better on post-laboratory tests than those participating in the organ-based laboratories.

  
Johnson A.L. & J.A. Farmer. Evaluation of traditional and alternative models in psychomotor laboratories for veterinary surgery. Journal of Veterinary Medical Education 1989;16(1):11–14.

Inanimate models effectively taught basic psychomotor skills, and had the advantage over live animals that they could be used repeatedly, enhancing the acquisition of motor proficiency.

Leonard W. H. A comparison of student performance following instruction by interactive videodisc versus conventional laboratory. Journal of Research in Science Teaching 1992;29(1):93–102.

In the use of videodisc or traditional laboratories, no significant difference was found for biology undergraduate students' laboratory grades. However, the videodisc group required one-half the time.

McCollum T.L. 1987. The effect of animal dissections on student acquisition of knowledge of and attitudes toward the animals dissected. Unpublished Doctoral Dissertation, University of Cincinnati.

Approximately 175 high school biology students taught frog structure, function, and adaptation via lecture performed better on a post-test than did approximately 175 high school biology students taught by doing a frog dissection.

More, D. & C.L. Ralph. A test of effectiveness of courseware in a college biology class. J. Educational Technology Systems 1992;21:79–84.

Biology knowledge of about 92 undergraduate biology students using computer courseware increased more than did that of approximately 92 students using traditional animal-based laboratories.

Olsen D, Bauer MS, Seim HB, Salman MD. Evaluation of a hemostasis model for teaching basic surgical skills. Vet Surg 1996;25(1):49-58. Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, USA.

The need for alternative methods of teaching veterinary medicine and surgery has increased in recent years because of increasing costs and changing public opinion. For these reasons a hemostasis model was developed that mimics the arteries and veins of the peripheral vascular system, and can be used to teach the basic skills involved in blood vessel ligation and division. This study evaluated the effectiveness of the fluid hemostasis model compared with using live animals for teaching these skills. Forty sophomore veterinary students participated in the study. Two groups of 20 students each received identical instruction in the basic techniques required for vessel ligation and division. The students then completed various exercises using inanimate models to objectively evaluate their psychomotor skills. Both groups then practiced the techniques for equal time periods; one group used the hemostasis model and the other performed a splenectomy on live dogs. After the practice session, the students were videotaped (for later evaluation), as they performed vessel ligations and divisions. The students then repeated the exercises using the inanimate models for evaluation of skills improvement. Questionnaire responses before and after the project were obtained to determine the students' views on the need for inanimate models for teaching purposes. Results of this study indicate that the hemostasis model was as effective as live animals for teaching the basic skills involved in blood vessel ligation. The students' opinions regarding the use of properly designed inanimate models for teaching these skills were dramatically changed.

[The model group had a lower number of errors and lower time to complete exercises; more students in the model group tied square knots and tight ligatures, and instrument grip was rated better for the model group.]

Phelps, J.L., J.O. Nilsestuen & S. Hosemann 1992. Assessment of effectiveness of videodisc replacement of a live animal physiology laboratory. Distinguished Papers Monograph, American Association for Respiratory Care.

Nursing students who studied using an interactive video program on cardiac output principles performed better on a post-test than did students taught by lecture and live animal physiology laboratory.

Samsel, R.W., G.A. Schmidt, J.B. Hall, L.D.H. Wood, S.G. Shroff & P.T. Schumacker. Cardiovascular physiology teaching: computer simulations vs. animal demonstrations. Advances in Physiology Education 1994;11:S36–46.

The roots of physiology lie in laboratory observation, and physiology courses continue to rely on laboratory observation to provide students with practical information to correlate with their developing base of conceptual knowledge. To this end, animal laboratories provide a functioning example of interactions among organ systems and a source of data for student analysis. However, there are continuing objections to using animals for teaching, and animal labs are costly in time and effort. As an alternative laboratory tool, computer software can simulate the operation of multiple organ systems: responses to interventions illustrate intrinsic organ behavior and integrated systems physiology. Advantages of software over animal studies include alteration of variables that are not easily changed in vivo, repeated interventions, and cost-effective hands-on student access. Nevertheless, simulations miss intangible aspects of experimental physiology, and results depend critically on the assumptions of the model. We used both computer and animal demonstrations in teaching cardiovascular physiology to first-year medical students. The students rated both highly, but the computer-based session received a higher rating. We believe that both forms of teaching have educational merit. At the introductory level, the computer appears to provide an effective alternative.

Papers demonstrating equivalent educational efficacy of humane alternatives (17)

Bauer, M.S., N. Glickman, L. Glickman, J.P. Toombs & P. Bill. Evaluation of the effectiveness of a cadaver laboratory during a fourth-year veterinary surgery rotation. Journal of Veterinary Medical Education 1992;19(2):77–84.

Learning outcomes were similar between two groups of fourth-year veterinary students, one who were taught surgery using a terminal and cadaver laboratory format, the other taught using survival laboratories.

See also: Bauer MS, Glickman N, Salisbury SK, Toombs JP, Prostredny JM. Surgical vs terminal animal laboratories to teach small animal surgery. Journal of Veterinary Medical Education 1992;19(2):54-58.

Carpenter LG, Piermattei DL, Salman MD, Orton EC, Nelson AW, Smeak DD, Jennings PB Jr, Taylor RA. A comparison of surgical training with live anesthetized dogs and cadavers. Vet Surg 1991;20(6):373-8. Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, USA.

[Although the abstract does not specify the source of the cadavers, use of ethically-sourced cadavers, from animal that have been euthanased for medical reasons, or died naturally or in accidents, is possible. Hence the cadavers were considered the more humane option.]

Cadavers were compared with live anesthetized dogs for their effectiveness as models for surgical training of veterinary medical students. One group of students was trained using cadavers, and a peer group was trained using live anesthetized dogs. Both groups then performed an intestinal anastomosis using a live subject. The time to completion of the procedure was recorded. The anastomoses and celiotomy closures were evaluated. Each anastomosis was isolated and pressure tested. Reviewers blindly scored each surgical team's performance based on actual inspection of the surgical site and on viewing videotapes of the procedure. The participants' attitudes toward the use of live animals in teaching and research were documented before and after training. No statistically significant differences could be detected between the two groups. The results suggest that some substitution of cadavers for live dogs in surgical training might be feasible.

Clarke KA. The use of microcomputer simulations in undergraduate neurophysiology experiments. Alternatives to Laboratory Animals 1987;14:134-40.

Cohen, P.S. & M. Block. Replacement of laboratory animals in an introductory psychology laboratory. Humane Innovations and Alternatives 1991;5:221–5.

Undergraduate students who studied feral pigeons in a city park scored equally well on evaluations as did students who studied operant conditioning with rats in a traditional lab.

Dewhurst DG, Brown GJ, Meehan AS. Microcom­puter simulations of laboratory experiments in physiology. Alternatives to Laboratory Animals 1988;15:280-9.
 

One undergraduate student cohort (group) performed a physiological frog experiment on an isolated sciatic nerve preparation, while another cohort used a computer simulation of the same experiment. There was no significant difference between student cohorts in marks derived for the laboratory report, the standard form of assessment for a wet lab.

[i.e., similar to Clark 1987].

Dewhurst DG, Hardcastle J, Hardcastle PT, Stuart E. Comparison of a computer simulation program and a traditional laboratory practical class for teaching the principles of intestinal absorption. Am J Physiol 1994;267(6 Pt 3):S95-104. Faculty of Health and Social Care, Leeds Metropolitan University, United Kingdom.
 

[Six undergraduate students working independently with a computer program gained equal knowledge, at one-fifth the cost, as eight supervised students using freshly killed rats.]

Here we describe an evaluation of the effectiveness, compared with a traditional laboratory, of an interactive computer-assisted learning (CAL) program, which simulates a series of experiments performed using isolated, everted sacs of rat small intestine. The program is aimed at undergraduate students of physiology and is designed to offer an alternative student-centered learning approach to the traditional laboratory-based practical class. The evaluative study compared two groups of second-year [UK] undergraduate students studying a module on epithelial transport: one group worked independently using the CAL program and associated learning materials, and the other group followed a conventional practical class approach, working in the laboratory under supervision. Knowledge gain of each group was measured by means of a test consisting of a range of question types (e.g., short-answer factual, calculation, interpretation) given to students before and after the module. Student attitude to both approaches was assessed by questionnaire, and the resource requirements were also compared. It was found that the knowledge gain of both groups of students was the same [and interestingly, the tutors who ran this teaching session did not identify laboratory/animal skills as primary learning objectives], that students had a positive attitude toward using CAL programs of this type [students using the CAL program became more positive about the experience after using it], and that the cost of the conventional laboratory-based approach was five times greater [the computer program was used with a printed workbook but no tutor support, whereas the wet lab required full tutor and some technical support]. The potential for integrating CAL programs into the undergraduate curriculum is discussed.

Dewhurst, D.G. & A.S. Meehan. Evaluation of the use of computer simulations of experiments in teaching undergraduate students. British J. Pharm. Proc. 1993;Suppl. 108:238.

Undergraduate students using computer simulations performed equally well as students using traditional approaches in physiology and pharmacology laboratories.

Downie, R. & J. Meadows. Experience with a dissection opt-out scheme in university level biology. Journal of Biological Education 1995;29(3):187–94.

Cumulative examination results of 308 undergraduate biology students who studied model rats were the same as those of 2,605 students who performed rat dissections.

Greenfield CL, Johnson AL, Shaeffer D & Hungerford LL. Comparison of surgical skills of students trained with models or live animals. Veterinary Surgery 1994;23(5):402.

Greenfield CL, Johnson AL, Schaeffer DJ, Hungerford LL. Comparison of surgical skills of veterinary students trained using models or live animals. J Am Vet Med Assoc 1995;206(12):1840-5. Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana 61801, USA.

Surgical skills of veterinary students were evaluated following training with dogs and cats, or soft tissue organ models; performance of each group was equivalent.

Hughes IE. Do computer simulations of laboratory practicals meet learning needs? Trends in Pharmacological  Sciences 2001;22(2):71-4. School of Biomedical Sciences, University of Leeds, LS2 9JT, Leeds, UK. i.e.hughes@leeds.ac.uk.
 

[The academic performance of students doing wet practicals (where students set up and manipulated their own tissue preparations, prepared their own solutions and calculated and prepared the drug doses and concentrations to be used) was compared with the performance of students using computer simulations. In each of five separate laboratory exercises, the performance of the students who used computer simulations was statistically significantly superior to that of the students who participated in the wet labs. However, examination results were equivalent or poorer when assessing details of the wet labs.]

There is a variety of pressures on pharmacology teachers to replace real laboratory practicals with simulations but do they help students achieve the required learning objectives? In this article, the marks obtained by students in a variety of assessments using 'wet' or simulated practicals are analysed. Poorer performance in practical write-ups by students doing 'wet' practicals compared with those doing simulations can be explained by the quality of the data that the students obtain. In examinations, students perform equally well except with questions that are related to the experimental details of 'wet' practicals; students taught using such 'wet' practicals perform better in response to these questions.

Kinzie, M.B., R. Strauss & J. Foss. The effects of an interactive dissection simulation on the performance and achievement of high school biology students. Journal of Research in Science Teaching 1993;30(8):989–1000.

Findings suggest that an interactive videodisc was at least as effective as actual dissection in promoting high school student learning of frog anatomy and dissection procedures.

Leathard, H.L. & D.G. Dewhurst. Comparison of the cost effectiveness of a computer-assisted learning program with a tutored demonstration to teach intestinal motility to medical students. ALT-J 1995;3(1):118–25.

No significant difference was found in the performances of preclinical medical students who used a traditional live animal laboratory and those who used a computer simulation on intestinal motility.

Lieb, M.J. 1985. Dissection: A valuable motivational tool or a trauma to the high school student? Unpublished Thesis, Master of Education, National College of Education, Evanston, Illinois.

Post-test scores were equivalent for high school students who dissected earthworms and those who received a classroom lecture on earthworm anatomy.

Pavletic, M.M., A. Schwartz, J. Berg, & D. Knapp. An assessment of the outcome of the alternative medical and surgical laboratory program at Tufts University. JAVMA 1994;205(1):97–100.

 
The school of Veterinary Medicine had made it the rule that all dogs undergoing major surgical procedures in its small animal teaching laboratories should be killed at the end of the procedure. However in 1988 12 students formally submitted a proposal requesting formation of an alternative small animal medical and surgical procedures course that would not include euthanasia of dogs, as they felt that it was morally wrong. An alternative training programme was developed to satisfy the moral concerns of the students, yet maintain the quality of their education. Cadavers were used of terminally ill or dead pets which were donated by the owners for the education of veterinary students, and were frozen until required. These students also spent 4 supplemental weeks in small animal surgery, 1 week in small animal medicine and 1 week in intensive care. Using this alternative training it was found that the use of cadavers during the 3rd year laboratory programme, when supplemented with additional clinical training during the 4th year, can provide training comparable to that provided in a conventional laboratory programme.

[Pavletic and others (1994) studied new graduates from the Tufts University veterinary class of 1990. The class included 12 students who had participated in an alternative small animal medical and surgical procedures course. These students and 36 of their conventionally-trained counterparts were assessed by questionnaires sent to their employers. Employers were asked to rate the competency of the new graduates at the time of hiring and 12 months later. It was found that there was no significant difference on either occasion in the abilities of the conventional and alternative graduates to perform common surgical, medical and diagnostic procedures; in their attitudes towards performing orthopaedic or soft tissue surgery; confidence in performing the listed procedures; or ability to perform those procedures without assistance.]

Strauss, R.T. and Kinzie, M.B. Student achievement and attitudes in a pilot study comparing an interactive videodisc simulation to conventional dissection. The American Biology Teacher 1994;56(7):398–402.

Two groups of high school students performed equally on a test following either animal dissection or interactive videodisc simulation.

White, K.K., L.G. Wheaton & S.A. Greene. Curriculum change related to live animal use: a four-year surgical curriculum. Journal of Veterinary Medical Education 1992;19:6–10.

After hesitancy in their first live tissue surgery, veterinary students from an alternative surgical laboratory program performed on par with students with a standard laboratory experience.

Papers demonstrating inferior educational efficacy of humane alternatives (3)

Cross TR & Cross VE.  Scalpel or mouse: a statistical comparison of real and virtual frog dissections. The Amer Biol Teacher 2004;66(6):408-11.
 

Over a two-year period, four classes of eleventh and twelfth grade high school AP Biology students were tested, none of whom had previously dissected a frog. 36 students dissected real frogs, while 38 dissected virtual frogs using the ‘Biolab Frog Dissection’ computer simulation. The students were given two days to complete their assignments, after which their identification and knowledge of the functions of organs and tissues was examined. The first year (two classes), all students were tested only via a laboratory practical using real frogs. The second year (two additional classes), students were tested in laboratory practicals using both real and virtual frogs. Students dissecting real frogs performed significantly better on the laboratory practicals utilizing real frogs. No significant difference was observed in the virtual laboratory practical test scores, however.

Matthews, D. Comparison of MacPig to fetal pig dissection in college biology. The American Biology Teacher 1998;60(3):228–9.

Eight biology undergraduate students who dissected fetal pigs scored significantly higher on an oral test with prosected fetal pigs than did twelve students who studied on a computerized pig (MacPig).

Balcombe J. The American Biology Teacher. 1998;60(8):555-6. Criticized the study because MacPig is not advanced enough for college level biology instruction, to which Matthews replied, adding nothing further of substance: Matthews D. Efficacy of fetal pig dissection alternatives questioned. The American Biology Teacher 1998b;61(2):88.

Smeak DD, Hill LN, Beck ML, Shaffer CA, Birchard SJ. Evaluation of an autotutorial-simulator program for instruction of hollow organ closure. Vet Surg 1994;23(6):519-28. Department of Veterinary Clinical Sciences, Ohio State University College of Veterinary Medicine, Columbus.

Forty students were randomly assigned into two study groups (traditional, T; and simulator, S) of 20 students each for a core operative practice laboratory. Students were randomly paired and their group assignment and identity remained anonymous to the evaluators throughout the study. Questionnaires were distributed to students to evaluate prior surgical experience and obtain learning resource use information. Before the evaluation sessions, both groups were given identical learning resource opportunities except students in Group S received hollow organ simulators and practice materials for gastrotomy closure. All students were forewarned that surgical instruction would not be available during the evaluation sessions. In the first live animal evaluation session, all student pairs were videotaped after which stomachs were harvested for gross evaluation of the surgical site. Group T performed an additional gastrotomy for video and gross evaluation 2 weeks later. Questionnaire, and gross and video evaluation results were compared statistically between groups and sessions. The hollow organ model did not suitably simulate live stomach tissue; the material was more fragile and stiff and suture cut-out was a problem even with appropriate suture tension and technique. The model was effective for teaching needle placement, instrument usage, creating proper tissue inversion, and methods to minimize instrument handling of tissue during gastrotomy closure. Prior practice with models did not boost student confidence during their live gastrotomy session. The autotutorials (ATs) were well received by students but did not sufficiently address how to manage mucosal eversion, suture tension, and bleeding encountered during live gastrotomy. AT viewing time positively correlated with mean total video score for Group T during both sessions. None of the students had prior experience performing hollow organ closure and no significant difference in experience level was evident between groups. Mean closure time was not significantly different between groups for session one (Group T, mean, 31.5 minutes, range, 18.4 to 53.4; Group S, mean, 28.2 minutes, range, 16.8 to 36), but was significantly reduced for session two (Group T, mean, 21.3 minutes, range, 13.9 to 31). This AT/simulator program does not significantly influence students' overall gastrotomy closure technique; gross and video evaluation scores were not significantly different between groups. Without instructor supervision, an additional gastrotomy experience did not improve surgical technique appreciably for Group T; however, these students performed the second procedure with more confidence and speed.

Other relevant papers (e.g., comparisons not involving harmful animal use) (74)

Ahmad, Asyia; Alnoah, Zaid; Kochman, Michael L.; Krevsky, Benjamin; Peikin, Steven R.; Mercogliano, Giancarlo; Bailey, Marie; Boynton, Robert and Reynolds, James C. Philadelphia GI Training Group; Philadelphia, PA, Camden, NJ, Wynnewood, PA. Endoscopic simulator enhances training of colonoscopy in a randomized, prospective, blinded trial. Gastrointestinal Endoscopy 2003;57(5):S1499.

The aim of this single blind, randomized, prospective, multi-center study was to determine the impact of using an endoscopic simulator (AccuTouch Endoscopy Simulator, Immersion Medical, Gaithersburg, MD) for the acquisition of skills to perform colonoscopy. Conclusion: The use of this endoscopic simulator enhanced the performance of colonoscopies by GI fellows within the first two months of training.

Allen SW & Chambers JN. Computer-assisted instruction of fundamental surgical motor skills. Journal of Veterinary Medical Education 1997;24(1):2-5.

A computer-assisted learning program, "The Surgical Techniques Auto-Tutorial Program," was developed for use as an introductory training tool of fundamental surgical motor skills such as instrument handling and knot tying. The program was well received by veterinary medical students. Although computer-assisted instruction was as effective as traditional methods in helping the students develop and retain some skill, direct instructor contact was necessary for the retention of other skills such as knot tying. It is concluded that when followed by instructor contact laboratories allowing feedback and reinforcement of operative skills, computer-assisted instruction was found to be a helpful introductory training tool for the development of fundamental surgical motor skills.

Anon. New endoscopy simulator helps train for needle aspiration. Laparoscopic Surgery Update.  2001;9(6):69.

   
Baillie, S.; Crossan, A.; Reid, S.; Brewster, S. Preliminary development and evaluation of a bovine rectal palpation simulator for training veterinary students. Cattle Practice 2003;11(2):101-6.

A computer based teaching tool has been developed using haptic technology to train veterinary students to examine the bovine reproductive tract, simulating rectal palpation. The student receives touch feedback from a haptic device while palpating virtual objects. The teacher can visualise the student's actions on a screen and give training and guidance. The teaching protocol is divided into several levels to support the progressive development of skills. Preclinical students are trained to orientate themselves in the three dimensional anatomical environment, to develop the correct exploratory technique and to identify key structures. More experienced students can be trained to reinforce, and further develop, existing skills. The properties of the virtual scene were assessed by veterinary surgeons. Evaluation of the teaching tool was conducted with fourteen veterinary students. After being trained with the device, each student carried out rectal examinations and assessed the effect of haptic training. The evaluation results, although preliminary, support haptic training as a possible method for enhancing the teaching of bovine rectal palpation.

Baillie S. Crossan A. Brewster S. Mellor D. Reid S Validation of a bovine rectal palpation simulator for training veterinary students. Studies in Health Technology & Informatics 2005;111:33-6.

Bovine rectal palpation is a necessary skill for a veterinary student to learn. However, lack of resources and welfare issues currently restrict the amount of training available to students in this procedure. Here we present a virtual reality based teaching tool -- the Bovine Rectal Palpation Simulator -- that has been developed as a supplement to existing training methods. When using the simulator, the student palpates virtual objects representing the bovine reproductive tract, receiving feedback from a PHANToM haptic device (inside a fibreglass model of a cow), while the teacher follows the student's actions on the monitor and gives instruction. We present a validation experiment that compares the performance of a group of traditionally trained students with a group whose training was supplemented with a simulator training session. The subsequent performance in the real task, when examining cows for the first time, was assessed with the results showing a significantly better performance for the simulator group.

Baillie S. Mellor DJ. Brewster SA. Reid SW. Integrating a bovine rectal palpation simulator into an undergraduate veterinary curriculum. Journal of Veterinary Medical Education 2005;32(1):79-85.

There are problems associated with teaching bovine rectal palpation to undergraduate veterinary students. The students need opportunities to examine enough cows to develop the required skills, but increasing student numbers and limitations on access to cows have made this more and more difficult to achieve. A virtual reality-based teaching tool, the Bovine Rectal Palpation Simulator, has been developed as a supplement to existing training methods. The student palpates computer generated virtual models of the bovine reproductive tract while interacting with a haptic (touch feedback) device. During training sessions, the instructor follows the student's actions inside the virtual cow on the computer screen and gives instruction. A trial integration of the simulator into the fourth-year bovine reproduction course was undertaken at the University of Glasgow Veterinary School during the 2003/2004 academic year. Students were offered two training sessions, and feedback was gathered using questionnaires. In the first session, all students were taught a range of basic skills using a standardized teaching protocol. The second training session was customized to each student's learning needs and included practice in dealing with a range of on-farm scenarios. Student feedback indicated that the training had been useful for learning various aspects of bovine rectal palpation and provided information that helped in the further development of the simulator as a teaching tool.

Chaer RA.  Derubertis BG.  Lin SC.  Bush HL.  Karwowski JK.  Birk D.  Morrissey NJ.  Faries PL.  McKinsey JF.  Kent KC. Simulation improves resident performance in catheter-based intervention: results of a randomized, controlled study. Annals of Surgery 2006;244(3):343-52.

OBJECTIVES: Surgical simulation has been shown to enhance the training of general surgery residents. Since catheter-based techniques have become an important part of the vascular surgeon's armamentarium, we explored whether simulation might impact the acquisition of catheter skills by surgical residents. METHODS: Twenty general surgery residents received didactic training in the techniques of catheter intervention. Residents were then randomized with 10 receiving additional training with the Procedicus, computer-based, haptic simulator. All 20 residents then participated in 2 consecutive mentored catheter-based interventions for lower extremity occlusive disease in an OR/angiography suite. Resident performance was graded by attending surgeons blinded to the resident's training status, using 18 procedural steps as well as a global rating scale. RESULTS: There were no differences between the 2 resident groups with regard to demographics or scores on a visuospatial test administered at study outset. Overall, residents exposed to simulation scored higher than controls during the first angio/OR intervention: procedural steps (simulation/control) (50 +/- 6 vs. 33 +/- 9, P = 0.0015); global rating scale (30 +/- 7 vs. 19 +/- 5, P = 0.0052). The advantage provided by simulator training persisted with the second intervention (53 +/- 6 vs. 36 +/- 7, P = 0.0006); global rating scale (33 +/- 6 vs. 21 +/- 6, P = 0.0015). Moreover, simulation training, particularly for the second intervention, led to enhancement in almost all of the individual measures of performance. CONCLUSION: Simulation is a valid tool for instructing surgical residents and fellows in basic endovascular techniques and should be incorporated into surgical training programs. Moreover, simulators may also benefit the large number of vascular surgeons who seek retraining in catheter-based intervention.

Dev P, Montgomery K, Senger S, Heinrichs WL, Srivastava S & Waldron K. Simulated medical learning environments on the Internet. Journal of the American Medical Informatics Association. 2002;9(5):437-47.

Learning anatomy and surgical procedures requires both a conceptual understanding of three-dimensional anatomy and a hands-on manipulation of tools and tissue. Such virtual resources are not available widely, are expensive, and may be culturally disallowed. Simulation technology, using high-performance computers and graphics, permits realistic real-time display of anatomy. Haptics technology supports the ability to probe and feel this virtual anatomy through the use of virtual tools. The Internet permits world-wide access to resources. We have brought together high-performance servers and high-bandwidth communication using the Next Generation Internet and complex bimanual haptics to simulate a tool-based learning environment for wide use. This article presents the technologic basis of this environment and some evaluation of its use in the gross anatomy course at Stanford University.

Dewhurst, D.G. & L. Jenkinson. The impact of computer-based alternatives on the use of animals in undergraduate teaching. ATLA 1995;23:521–30.

Use of computer packages saved teaching staff time, were less expensive, were an effective and enjoyable mode of undergraduate biomedical student learning, and significantly reduced animal use.

Dhein CR & Memon M. On-line continuing education at the College of Veterinary Medicine, Washington State University. Journal of Veterinary Medical Education (Special issue: Continuing veterinary education) 2003;30(1):41-6.

The use of on-line continuing education overcomes the potential obstacles of time and distance and reduces the expenses associated with continuing education. The asynchronous nature of the delivery system allows participants to spend as much or little time with the materials as they choose, allows them to start and stop when they wish (within the access duration) and gives them the ability to access the materials repeatedly during the available time-frame. The on-line format breaks geographic barriers, making it an excellent tool for international education. Our experiences at Washington State University with on-line continuing education support the view that there is demand for on-line education from veterinary medical professionals, as well as from animal owners. The on-line delivery system that has evolved at Washington State University has been well received by the majority of participants. The design of the delivery system has been kept consistent and relatively simple, in order to allow use by participants using a wide variety of computers and methods of Internet access. The team approach used in the development of these courses proved effective and provided for more expedient development of new courses. The content provider was not required to use advanced technical skills to participate. The site designer used templates created by an experienced computer programmer to build the site. The format used in our on-line education programs has also been used in our veterinary curriculum. The didactic components of two small animal specialties are currently taught by content experts outside our college, using the format developed for distance education. The education continuum, from veterinary school to the self-directed, lifelong learning of a practicing veterinarian, is enhanced by exposure to distance education in the veterinary curriculum.

Di Giulio E, Fregonese D, Casetti T, Cestari R, Chilovi F, D'Ambra G, Di Matteo G, Ficano L & Delle Fave G. Training with a computer-based simulator achieves basic manual skills required for upper endoscopy: a randomized controlled trial. Gastrointestinal Endoscopy 2004;60(2):196-200.

Dyson DH. Non-linear, visual-rich supplemental material designed for an introductory course in veterinary anaesthesia. Journal of Veterinary Medical Education 2003;30(4):360-3.

A possible reason for superficial learning in an introductory anaesthesia course was considered to be a lack of visual reinforcement at the time of examination preparation. Students had limited access to live animal laboratories and clinical cases during the course, reducing their ability to depend on experiential learning. In an attempt to improve student learning, simple presentation software was used to develop a supplemental CD. The design involved multiple PowerPoint presentations that incorporated text, pictures, videos and self-assessments. Non-linear exploration of the topics covered was made possible by extensive use of hyperlinks within and between presentations, moving the student to definitions, background material, videos, advanced details and previously covered information. Comments received from students on a prototype were positive overall, and improvements were made related to their feedback. Other supplemental materials and lecture presentations can easily incorporate the techniques described here.

Edmond CV Jr. Impact of the endoscopic sinus surgical simulator on operating room performance. Laryngoscope 2002;112(7 Pt 1):1148-58.

OBJECTIVES/HYPOTHESIS: The aim of this study is to evaluate an endoscopic sinus surgical simulator (ESS) as a training device and to introduce a methodology to assess its impact on actual operating room performance. STUDY DESIGN: Prospective evaluation of the endoscopic sinus surgical simulator as a trainer. METHODS: Ten junior and senior ear, nose and throat residents served as subjects, some of whom had prior training with the simulator. The evaluation team collected several measures, which were analyzed for a statistical correlation, including simulator scores, operating room performance rating, ratings of videotaped operating room procedures, and surgical competency rating. RESULTS: These findings suggest the ESS simulator positively affects initial operating room performance across all measures as judged by senior surgeons rating anonymous videotapes of those procedures. The two simulation-trained residents were rated consistently better than the other two residents across all measures. These differences approached statistical significance for two items: anterior ethmoidectomy (P =.06; P  CONCLUSIONS: The endoscopic sinus surgical simulator is a valid training device and appears to positively impact operating room performance among junior otolaryngology residents.

Ellaway R. Pettigrew G. Rhind S. Dewhurst D. The Edinburgh Electronic Veterinary Curriculum: an online program-wide learning and support environment for veterinary education. Journal of Veterinary Medical Education 2005;32(1):38-46.

The Edinburgh Electronic Veterinary Curriculum (EEVeC) is a purpose-built virtual learning support environment for the veterinary medicine program at the University of Edinburgh. It is Web based and adapted from a system developed for the human medical curriculum. It is built around a set of databases and learning objects and incorporates features such as course materials, personalized timetables, staff and student contact pages, a notice board, and discussion forums. The EEVeC also contains global or generic resources such as information on quality enhancement and research options. Many of these features contribute to the aim of building a learning community, but a challenge has been to introduce specific features that enhance student learning. One of these is a searchable lecture database in which learning activities such as quizzes and computer-aided learning exercises (CALs) can be embedded to supplement a synopsis of the lecture and address the key needs of integration and reinforcement of learning. Statistics of use indicate extensive student activity during evenings and weekends, with a pattern of increased usage over the years as more features become available and staff and students progressively engage with the system. An essential feature of EEVeC is its flexibility and the way in which it is evolving to meet the changing needs of the teaching program.

Erickson, H.H. & V.L. Clegg. Active learning in cardiovascular physiology. In Modell, H.I., & Michael, J.A. (Eds). Promoting Active Learning in the Life Science Classroom. Annals of the New York Academy of Sciences 1993;701;107–8.

Of fourteen learning methods for basic cardiac teaching and ECG interpretation, computer-based active learning was rated the highest in veterinary student evaluations.

Galle U & Bubna-Littitz H. Model for teaching venous puncture techniques in the dog. Possibility for reducing stress to living experimental animals in student teaching. [German] Zentralblatt fur Veterinarmedizin, A 1983;30(10):796-9.

For obtaining practice in intravenous injection or bleeding in the dog a practice model is described which has given good results. A formalin-fixed preparation of a canine extremity in which the cephalic vein is replaced by a silicon tube is simple and cheap to set up and has the advantage of simulating the living animal. Using this model, the correct technique for injection and the reduced number of venous puncture attempts in the live animal can reduce to a minimum the stress imposed on experimental dogs.

Garuda, Sanjay; Keshavarzian, Ali; Losurdo, John; Brown, Michael D.; Rush Presbyterian St. Luke's Medical Center, Chicago, IL. Efficacy of a computer-assisted endoscopic simulator in training residents in flexible sigmoidoscopy. Presented as a poster abstract at the 2002 ACG.

Use of a simulator (AccuTouch Endoscopy Simulator, Immersion Medical, Gaithersburg, MD) reduced the number of procedures required to reach competency.

Grantcharov TP.  Kristiansen VB.  Bendix J.  Bardram L.  Rosenberg J.  Funch-Jensen P. Randomized clinical trial of virtual reality simulation for laparoscopic skills training. British Journal of Surgery 2004;91(2):146-50.

BACKGROUND: This study examined the impact of virtual reality (VR) surgical simulation on improvement of psychomotor skills relevant to the performance of laparoscopic cholecystectomy. METHODS: Sixteen surgical trainees performed a laparoscopic cholecystectomy on patients in the operating room (OR). The participants were then randomized to receive VR training (ten repetitions of all six tasks on the Minimally Invasive Surgical Trainer-Virtual Reality (MIST-VR)) or no training. Subsequently, all subjects performed a further laparoscopic cholecystectomy in the OR. Both operative procedures were recorded on videotape, and assessed by two independent and blinded observers using predefined objective criteria. Time to complete the procedure, error score and economy of movement score were assessed during the laparoscopic procedure in the OR. RESULTS: No differences in baseline variables were found between the two groups. Surgeons who received VR training performed laparoscopic cholecystectomy significantly faster than the control group (P=0.021). Furthermore, those who had VR training showed significantly greater improvement in error (P=0.003) and economy of movement (P=0.003) scores. CONCLUSION: Surgeons who received VR simulator training showed significantly greater improvement in performance in the OR than those in the control group. VR surgical simulation is therefore a valid tool for training of laparoscopic psychomotor skills and could be incorporated into surgical training programmes.

Guy, J.F. & A.J. Frisby. Using interactive videodiscs to teach gross anatomy to undergraduates at Ohio State University. Academic Medicine 1992;67:132–3.

To determine whether interactive-videodisc lessons can effectively replace some of the labor-intensive laboratories in human gross anatomy, pre-nursing and allied-medical-professions undergraduates at The Ohio State University were randomly assigned to either a traditional cadaver-demonstration lab or an interactive-videodisc computer lab covering the same material. In a one-unit pilot study in the autumn quarter of 1989 (involving 190 students) and a full-quarter course in the spring quarter of 1991 (283 students), the performances of the computer-lab students were not significantly different from those of the students in the traditional cadaver-demonstration-lab groups.

Hadzimahmutovic Z.  Healy DL.  Tsaltas J.  Lawrence AS.  Brown TIH.  Flanagan B. Gynaecological endoscopy training simulators. Gynaecological Endoscopy  1999;8(3):129-35.

Objective: To introduce the concept of simulator training to gynaecological surgeons and to inform them of the current state of worldwide research into the development of a laparoscopic simulator. Attributes: Virtual-reality technology enables the surgeon not only to perform diagnostic procedures, but also to practice entire surgical operations on a mannikin, while observing and interacting with a realistic computer-generated gynaecological environment on-screen. The benefits of such simulator training are twofold: surgeons will be at a higher point on the learning curve before their first operation on a patient, and patients should enjoy better quality of care. Research: Great confidence in the potential of virtual-reality technology in gynaecology, and medicine in general, has generated considerable international interest. As a result, much research and development effort is going into the creation of a gynaecological endoscopy simulator. Although several laparoscopic simulators are near their completion stage, there are no commercially available systems as yet. Medical education: A plan for the successful implementation of simulator training in gynaecology through preceptorship and credentialling programs, is outlined. Use of simulator training in gynaecology and other medical fields, is expected to become mole popular with further advances in technology.

Hall RE, Plant JR, Bands CJ, Wall AR, Kang J & Hall CA. Human patient simulation is effective for teaching paramedic students endotracheal intubation. Academic Emergency Medicine 2005;12(9):850-5.

OBJECTIVES: The primary purpose of this study was to determine whether the endotracheal intubation (ETI) success rate is different among paramedic students trained on a human patient simulator versus on human subjects in the operating room (OR). METHODS: Paramedic students (n = 36) with no prior ETI training received identical didactic and mannequin teaching. After randomization, students were trained for ten hours on a patient simulator (SIM) or with 15 intubations on human subjects in the OR. All students then underwent a formalized test of 15 intubations in the OR. The primary outcome was the rate of successful intubation. Secondary outcomes were the success rate at first attempt and the complication rate. The study was powered to detect a 10% difference for the overall success rate (alpha = 0.05, beta = 0.20). RESULTS: The overall intubation success rate was 87.8% in the SIM group and 84.8% in the OR group (difference of 3.0% [95% confidence interval {CI} = -4.2% to 10.1%; p = 0.42]). The success rate on the first attempt was 84.4% in the SIM group and 80.0% in the OR group (difference of 4.4% [95% CI = -3.4% to 12.3%; p = 0.27]). The complication rate was 6.3% in the SIM group and 4.4% in the OR group (difference of 1.9% [95% CI = -2.9% to 6.6%; p = 0.44]). CONCLUSIONS: When tested in the OR, paramedic students who were trained in ETI on a simulator are as effective as students who trained on human subjects. The results support using simulators to teach ETI.

Hariri S.  Rawn C.  Srivastava S.  Youngblood P.  Ladd A. Evaluation of a surgical simulator for learning clinical anatomy. Medical Education 2004;38(8):896-902.

BACKGROUND: New techniques in imaging and surgery have made 3-dimensional anatomical knowledge an increasingly important goal of medical education. This study compared the efficac