Volume 47 Issue 4, July 2020, pp. 465-474

With increasing pressure on university teaching hospital caseloads, veterinary students are increasingly being taught basic desexing skills during their final-year extramural rotations or as new graduates in practice. A cross-sectional survey of New Zealand veterinarians was conducted to elicit information about their experiences supervising these cohorts. Of the 162 respondents who had supervised at least one final-year veterinary student, only 95 (58.6%) allowed students to perform desexing surgeries and the most common procedures they allowed students to perform were cat neuters (96%) followed by cat spays (64%), dog neuters (63%), and dog spays (24%). The time needed to supervise students, the liability of students operating on client-owned animals, and students’ poor basic instrument, tissue, and suture handling skills were cited as major deterrents. Breaks in sterility and dropped pedicles were the most frequently reported complications, although these still occurred only occasionally or rarely. Of the 101 respondents who had supervised at least one new graduate, all but one provided surgical mentoring. It took an average of 3.3 dog neuters, 8 dog spays, 2.4 cat neuters, and 4.7 cat spays before respondents were comfortable letting new graduates perform surgery unassisted. Respondents generally expected new graduates to perform dog spays in under 60 minutes, cats spays and dog neuters in under 30 minutes, and cat neuters in under 10 minutes. Although most respondents agreed that students needed more hands-on experience with live animal surgery, the main clinical skills deficiencies identified were ones that could easily be trained and practiced on simulated models.

Canine and feline spays are among the most common surgical procedures performed in first-opinion companion animal practice and considered to be a Day One clinical skills competency for graduating veterinarians.13 With increasing class sizes and typically stable or decreasing caseloads at veterinary teaching hospitals, it can be difficult for students to gain adequate experience with these procedures through the traditional curriculum. Consequently, most hands-on surgical training occurs either during their final-year extramural rotations or as new graduates.4,5 This has raised concerns for several reasons, including the reluctance of many clinics to let students perform surgical procedures on client-owned animals;6 the discrepancies between the surgical techniques taught in veterinary schools versus those taught in first-opinion practices;7 and the variable level of mentoring provided by veterinary practices to new graduates.8 The result is that many students are entering practice with limited confidence or competence in desexing procedures,4,5 which is a source of professional stress and burnout for new graduates,6 and a risk factor for peri-operative surgical complications for their patients.9

In a recent survey of Massey students on completion of their final clinical year, we found that approximately 80% of the desexing procedures they had performed prior to graduation were done on extramural rotations rather than at the veterinary teaching hospital due to limited teaching caseloads.5 As part of ongoing efforts to increase desexing surgical training opportunities, we recently launched a new weekend volunteer program that provides low-cost cat desexing to means-tested owners in the local community while giving students more hands-on surgical experience before starting their final clinical year and during final-year rotations.10 To enable the long-term evaluation of program efficacy, we conducted the present national cross-sectional survey. In one section, we collected baseline information on the experiences and opinions of New Zealand veterinarians towards supervising final-year students and new graduates performing desexing surgeries during the previous 12-month period.

We conducted an online cross-sectional survey of New Zealand veterinarians from April 1, 2018, to May 30, 2018, with the objectives of collecting data on desexing surgical techniques used in clinical practices and experiences with supervising veterinary students and new graduates in performing desexing procedures. The survey was advertised on April 1, 2018, by the research team through social media channels, the New Zealand Veterinary Association Facebook page, and by the Veterinary Council of New Zealand through an e-mail sent to the 3,142 veterinarians registered in their national database. Of these, 3,043 veterinarians had a valid contact address in New Zealand. No information was available on practice type to be able to accurately estimate the baseline number of veterinarians who were actively engaged in small animal veterinary practice at the time of the survey. A short article about the research study was also featured in the April 2018 edition of VetScript, which is a monthly journal for veterinary professionals in New Zealand published by the New Zealand Veterinary Association.11 All advertisements contained a brief description of the study as well as a hyperlink to complete the survey via an online survey tool. No additional advertisements were made during the study time period.

The survey contained six sections that asked participants about their (1) general background, (2) techniques for performing feline spay procedures, (3) techniques for performing canine spay procedures, (4) experiences supervising veterinary students with desexing procedures during their final-year clinical rotations, (5) experiences supervising new graduates with desexing procedures, and (6) additional comments. A copy of the full survey (How Many Ways to Spay?) is provided in the supplementary online materials. The results from sections 2 and 3 on techniques for performing desexing surgical procedures will be described in forthcoming articles. This research study was reviewed and approved by the Massey University Human Ethics Committee: Southern A, Application 18/01.

In the general background section, we asked participants about their (1) graduation year; (2) practice type (small animal exclusive, large animal exclusive, mixed small and large animal, or other); (3) approximate number of desexing procedures completed before graduation; (4) confidence in performing desexing surgeries at the time of graduation (scale of 1 = least confident to 10 = most confident); (5) approximate number of surgeries after graduation to feel completely confident; (6) level of support from first employer in performing desexing surgeries (very poor, poor, adequate, good, very good); and (7) average number of desexing procedures currently performed per month.

In section 5 on experiences with supervising BVSc students, we asked participants (1) how many students were supervised over the past 12 months; (2) how frequently students were supervised (daily, weekly, monthly, or other); and (3) whether or not students were allowed to perform desexing surgeries at the practice (yes or no). If participants answered “no” to (3), they were asked to indicate the reasons why students were not allowed to perform procedures. If participants answered “yes” to (3), they were asked additional follow-up questions about which procedures students were allowed to perform, how they rated the students’ general skills in various aspects of the surgical techniques, and how often various complications occurred when students were performing the procedures. All participants were also asked if they would be more likely to allow fifth-year students to perform desexing procedures if the students had more surgical experience before starting clinical rotations.

In section 6, on experiences with supervising new graduates, participants were asked (1) how many new graduates they supervised or hired over the past 12 months; (2) how important the graduates’ ability to perform desexing procedures was in the hiring decision (scale of 1 = not important to 10 = extremely important); (3) level of concern over potential complications with desexing surgeries when the graduates first started (extremely worried, quite worried, indifferent, reasonably confident, completely confident); (4) rating of clinical skills in various aspects of desexing surgeries (very poor, poor, satisfactory, good, very good); (5) level of support provided to the new graduate (scrubbed in on procedures, visually checked ligatures, ensured vet on site to assist, none, and/or other); (6) approximately how many surgeries before they were confident in letting the new graduates perform the procedures unassisted; (7) how many minutes it should take new graduates to perform the procedures when they first start employment; and (8) free-text comments on what could be done at their practice to improve the level of mentoring and support provided to new graduates.

Data from the online survey tool were downloaded and imported in the R statistical software package for cleaning and analysis.a Basic descriptive statistics were generated for all of the quantitative study variables. Comments in the free-text fields were manually classified into themes to capture the wider range of opinions expressed by survey respondents.

The survey was attempted by 619 individuals located in New Zealand with 472 individuals providing sufficiently complete responses for analysis. Of the 472, there were 162 respondents (34.3%) who reported supervising at least one BVSc student within the previous 12 months and 101 respondents (21.4%) who reported supervising at least one new graduate within the previous 12 months.

Respondent Demographics

Of the 472 individuals who provided complete survey responses, 352 (74.6%) graduated from Massey University, 49 (10.4%) graduated from a British veterinary school, 20 (4.2%) graduated from an Australian veterinary school, 8 graduated from a North American veterinary school (1.5%), and the remaining 43 (9.1%) graduated from other veterinary schools worldwide. The mean number of years since graduation was 16.8 (min = 0 years, Q1 = 3 years, median = 15 years, Q3 = 25 years, max = 50 years). The majority of respondents were either small animal exclusive practitioners (232/472; 49.2%) or mixed animal practitioners (217/472; 46.0%).

Personal Experiences as Students and New Graduates

The average number of desexing surgeries performed under supervision prior to graduation was 3.3 dog neuters (min = 0, Q1 = 1, median = 2, Q3 = 3, max = 100), 2.1 dog spays (min = 0, Q1 = 1, median = 1, Q3 = 2, max = 60), 6.1 cat neuters (min = 0, Q1 = 2, median = 4, Q3 = 8, max = 60), and 3.9 cat spays (min = 0, Q1 = 1, median = 2, Q3 = 5, max = 50). When asked on a scale of 1 (least confident) to 10 (most confident) how confident they felt performing each desexing surgery at the time of graduation, respondents reported an average score of 5.7 for dog neuters (min = 1, Q1 = 4, median = 6, Q3 = 8), max = 10), 3.3 for dog spays (min = 1, Q1 = 1, median = 3, Q3 = 5, max = 10), 7.3 for cat neuters (min = 1, Q1 = 6, median = 8, Q3 = 9, max = 10), and 5.3 for cat spays (min = 1, Q1 = 4, median = 5, Q3 = 7, max = 10).

The average number of desexing surgeries it took after graduation to feel completely confident in performing the procedures was 7.2 for dog neuters (min = 0, Q1 = 3, median = 5, Q3 = 10, max = 100), 21.5 for dog spays (min = 0, Q1 = 10, median = 15, Q3 = 25, max = 100), 4.4 for cat neuters (min = 0, Q1 = 1, median = 3, Q3 = 5, max = 30), and 9.9 for cat spays (min = 0, Q1 = 5, median = 6, Q3 = 10, max = 100). Only 126 out of 329 individuals (38.3%) who completed the question on changes in cat spay techniques over time and 139/277 individuals (50.2%) who completed the question on changes in dog spay techniques over time were still using the same techniques they had been taught in veterinary school.

The respondents’ level of confidence in performing desexing surgeries at the time of graduation was directly related to the number of desexing procedures performed before graduation (Figure 1) and inversely related to the number of procedures it took after graduation before they felt completely confident in performing the procedures (Figure 2). In other words, the more procedures performed during veterinary school, the more confident the respondents were at graduation, and the less time needed to become fully confident.

Figure 1: Relationship between level of confidence at time of graduation and number of procedures performed before graduation for (a) dog neuters, (b) dog spays, (c) cat neuters, and (d) cat spays

Figure 2: Relationship between level of confidence at time of graduation and number of supervised procedures it took after graduation to feel completely confident in performing (a) dog neuters, (b) dog spays, (c) cat neuters, and (d) cat spays

When asked about the level of support provided by their first employers to improve desexing surgical skills, 123 (26.1%) rated it as “very good,” 108 (22.9%) rated it as “good,” 98 (20.7%) rated it as “adequate,” 76 (16.1%) rated it as “poor,” 60 (12.7%) rated it as “very poor,” and 7 (1.5%) did not provide a response.

Experiences Supervising Veterinary Students

There were 162 respondents who reported supervising at least one BVSc student within the previous 12 months. Of these, 61 (37.7%) did not allow students to perform desexing procedures, 95 (58.6%) allowed students to perform desexing procedures, and 6 (3.7%) did not provide a response. The reasons cited by the 61 respondents for not allowing students to perform desexing procedures were: the liability of having students perform procedures on client-owned animals (38; 62%); time involved in supervising students through desexing procedures (34; 56%); not being comfortable knowing how to teach surgical skills to students (5; 8%); inadequate desexing surgical caseload when students were there (30; 49%); concerned about level of student surgical skills and prior knowledge (33; 54%); and concerned about client perception if they knew students performed surgery (25; 41%). Additional reasons listed in the free-text section included: concern over increased post-surgical pain for the animals; competition for cases with new graduates in the practice; and concerns over the personal ability to fix any complications.

Of the 95 respondents who did allow students to perform desexing procedures, 60 (63%) allowed students to perform dog neuters, 23 (24%) allowed students to perform dog spays, 91 (96%) allowed students to perform cat neuters, and 61 (64%) allowed students to perform cat spays. Table 1 presents a summary of how respondents rated the general knowledge and skills of final-year students. Most students were generally satisfactory or good with sterile preparation, knowledge of surgical landmarks, and knowledge of surgical procedural steps. However, approximately a third were rated as poor or very poor for knot tying and knot security, tissue and instrument handling, and selection of appropriate suture materials.

Table

Table 1: Rating of the general knowledge and skills of final-year veterinary students in different areas of desexing procedures

Table 1: Rating of the general knowledge and skills of final-year veterinary students in different areas of desexing procedures

Very poor Poor Satisfactory Good Very good N/A
Sterile preparation (i.e., scrubbing, gowning, gloving) 0 (0%) 9 (9.5%) 29 (30.5%) 46 (48.4%) 9 (9.5%) 2 (2.1%)
Knowledge of surgical landmarks 0 (0%) 15 (15.8%) 43 (45.2%) 31(32.6%) 4 (4.2%) 2 (2.1%)
Knowledge of surgical procedural steps 0 (0%) 15 (15.8%) 46 (48.4%) 29 (30.5%) 3 (3.2%) 2 (2.1%)
Knot tying and knot security 0 (0%) 25 (26.3%) 48 (50.5%) 15 (15.8%) 2 (2.1%) 5 (5.3%)
Tissue and instrument handling 1 (1.1%) 37 (38.9%) 41 (43.2%) 10 (10.5%) 2 (2.1%) 4 (4.2%)
Selection of suture material and size 3 (3.2%) 33 (34.7%) 44 (46.3%) 9 (9.5%) 1 (1.1%) 5 (5.3%)
General confidence 3 (3.2%) 22 (23.2%) 56 (58.9%) 9 (9.5%) 1 (1.1%) 4 (4.2%)

N/A = not applicable

A summary of the frequency of complications occurring when final-year students were allowed to perform desexing procedures is presented in Table 2. The most frequently reported complications were breaks in sterility during the procedure followed by dropped pedicles and post-operative skin infections. However, it should be noted that these were mainly occasional or rare occurrences.

Table

Table 2: Frequency of complications when final-year veterinary students were allowed to perform desexing procedures in clinical practices

Table 2: Frequency of complications when final-year veterinary students were allowed to perform desexing procedures in clinical practices

Never Rarely Occasionally Frequently N/A
Break in sterility during procedure 18 (18.9%) 38 (40.0%) 29 (30.5%) 5 (5.3%) 5 (5.3%)
Dropped pedicles 43 (45.3%) 26 (27.3%) 15 (15.8%) 2 (2.1%) 9 (9.4%)
Intra-operative bleeding from uterine or ovarian pedicles 39 (41.1%) 35 (36.8%) 8 (8.4%) 2 (2.1%) 11 (11.6%)
Post-operative bleeding 55 (57.9%) 24 (25.2%) 7 (7.4%) 0 (0.0%) 9 (9.5%)
Post-operative skin infections 47 (49.5%) 24 (24.2%) 13 (13.7%) 3 (3.2%) 8 (8.4%)
Excessive post-operative pain 45 (47.4%) 29 (30.5%) 12 (12.6%) 2 (2.1%) 7 (7.4%)

N/A = not applicable

Overall, 110 of the 162 respondents (67.9%) indicated that they would be more willing to let students perform desexing procedures if the students had more surgical experience before starting final-year extramural rotations. Some of the main concerns flagged in the free-text comments included the following: the additional time needed to teach students with no prior hands-on experience; the wide variation in the students’ basic clinical ability levels, which made it difficult to judge their safety in performing surgery on client-owned animals; not wanting to teach something different than the university; and not believing that it is the role of private practices to be teaching students. One respondent highlighted the need for better communication with the profession about what kind of competency students and new graduates should have with desexing. Another respondent highlighted the importance of teaching students good instrument and tissue handling from day 1 in the anatomy dissection labs to prevent bad habits from forming. General student attitude and confidence also appeared to be important for some respondents in deciding whether to let students perform surgeries.

Experiences Supervising New Graduates

There were 101 respondents who reported supervising at least one new graduate within the previous 12 months. When asked on a scale of 1 (not important) to 10 (extremely important) how important the new graduates skills in desexing procedures were in the hiring decision, the average response was 3.5 (min = 1, Q1 = 1, median = 3, Q3 = 5, max = 10). Only one respondent reported providing no support to the new graduate for learning the desexing procedures. Out of the remaining 100, 72 scrubbed in with the new graduate on procedures, 63 visually checked the ligatures and closures, and 22 always ensured an experienced veterinarian was on site to assist if needed. Other methods of support reported in the free-text comments were having them watch experienced surgeons perform the procedures first, starting on cat spays before moving to dog spays, and ensuring that the new graduates were given easier surgeries for their first procedures. Interestingly, one respondent commented on the need to modify the new graduate’s taught technique to minimize complications, although they did not specify what was considered wrong about the taught technique.

The level of concern about different surgical complications occurring when new graduates were performing surgery is presented in Table 3. The highest levels of concern were around placing skin sutures too tightly, taking longer to do the surgery than necessary, and the risk of post-operative bleeding. The lowest levels of concern were around post-operative pain management, leaving ovarian remnants behind, and ligating the ureters.

Table

Table 3: Veterinarians’ level of concern about different surgical complications occurring when new graduates were performing desexing surgeries

Table 3: Veterinarians’ level of concern about different surgical complications occurring when new graduates were performing desexing surgeries

1 2 3 4 5
(Extremely worried) (Quite worried) (Indifferent) (Reasonably confident) (Completely confident) N/A
Post-operative bleeding occurring 3 (3.0%) 27 (26.7%) 19 (18.9%) 36 (35.6%) 4 (4.0%) 12 (11.9%)
Leaving ovarian remnants behind 3 (3.0%) 13 (12.8%) 18 (17.8%) 48 (47.5%) 6 (5.9%) 13 (12.9%)
Taking longer to do a surgery than you think is appropriate 4 (4.0%) 28 (27.7%) 38 (37.6%) 19 (18.8%) 1 (1.0%) 11 (10.9%)
Performing too large a skin incision 1 (1.0%) 17 (16.8%) 48 (47.5%) 19 (18.8%) 4 (4.0%) 12 (11.9%)
Performing too small a skin incision 2 (2.0%) 12 (11.9%) 43 (42.6%) 25 (24.8%) 5 (5.0%) 14 (13.9%)
Post-operative infection occurring 0 (0.0%) 15 (14.9%) 27 (26.7%) 41 (40.6%) 4 (4.0%) 14 (13.9%)
Ligating ureters 2 (2.0%) 9 (8.9%) 20 (19.8%) 49 (48.5%) 8 (7.9%) 13 (12.9%)
Suture material selection 2 (2.0%) 9 (9.0%) 29 (28.7%) 44 (43.6%) 6 (5.9%) 11 (10.9%)
Herniation 1 (1.0%) 16 (15.8%) 31 (30.7%) 38 (37.6%) 4 (4.0%) 11 (10.9%)
Placing skin sutures too tightly 3 (3.0%) 36 (35.6%) 22 (21.8%) 25 (24.8%) 3 (3.0%) 12 (11.9%)
Post-operative pain in patient 1 (1.0%) 15 (14.9%) 16 (15.8%) 49 (48.5%) 7 (6.9%) 13 (12.9%)

N/A = not applicable

The rating of new graduate knowledge and skills in different areas of the desexing procedures is presented in Table 4. In general, the majority of new graduates had at least satisfactory sterile preparation, knowledge of surgical landmarks, and knowledge of procedural steps. Slightly more issues were reported with tissue and instrument handling, as well as knot tying and knot security, with almost a quarter of new graduates rated as either poor or very poor. Approximately a quarter of new graduates were seen as lacking overall confidence.

Table

Table 4: Rating of general knowledge and skills of new graduates in different areas of desexing procedures

Table 4: Rating of general knowledge and skills of new graduates in different areas of desexing procedures

Very poor Poor Satisfactory Good Very good N/A
Sterile preparation (i.e., scrubbing, gowning, gloving) 1 (1.0%) 2 (2.0%) 22 (21.8%) 41 (40.6%) 24 (23.8%) 11 (10.9%)
Knowledge of surgical landmarks 1 (1.0%) 9 (8.9%) 28 (27.7%) 36 (35.6%) 17 (16.8%) 10 (9.9%)
Knowledge of surgical procedural steps 1 (1.0%) 7 (6.9%) 29 (28.7%) 39 (38.6%) 15 (14.9%) 10 (9.9%)
Knot tying and knot security 2 (2.0%) 21 (20.8%) 40 (39.6%) 22 (21.8%) 6 (5.9%) 10 (9.9%)
Tissue and instrument handling 2 (2.0%) 22 (21.8%) 41 (40.6%) 22 (21.8%) 4 (4.0%) 10 (9.9%)
Selection of suture material and size 2 (2.0%) 14 (13.9%) 45 (44.6%) 26 (25.7%) 4 (4.0%) 10 (9.9%)
General confidence 5 (5.0%) 19 (18.9%) 36 (35.6%) 29 (28.7%) 1 (1.0%) 11 (10.9%)

N/A = not applicable

When asked on average how many supervised surgeries it took before they were confident in letting the new graduate perform the procedures unassisted, the respondents answered 3.3 for dog neuters (min = 0, Q1 = 1, median = 2, Q3 = 5, max = 10), 8 for dog spays (min = 1, Q1 = 3, median = 5, Q3 = 10, max = 30), 2.4 for cat neuters (min = 0, Q1 = 1, median = 1, Q3 = 2, max = 20), and 4.7 for cat spays (min = 0, Q1 = 2, median = 4, Q3 = 5, max = 30).

Respondents believed that it should take new graduates on average 32 minutes to perform a dog neuter (min = 5, Q1 = 30, median = 30, Q3 = 40, max = 60), 66 minutes to perform a dog spay (min = 30, Q1 = 60, median = 60, Q3 = 80, max = 120), 10 to perform a cat neuter (min = 1, Q1 = 5, median = 10, Q3 = 10, max = 30), and 30 minutes to perform a cat spay (min = 15, Q1 = 30, median = 30, Q3 = 45, max = 60).

In the free-text comments around what could be done to improve the level of mentoring, there was a broad range of suggestions. Some of the main challenges reported were around the practices being too busy to mentor new graduates adequately, and there being insufficient surgical caseloads at the practice for the new graduates to gain experience. Three respondents reported issues with the new graduates refusing to modify their surgical technique from what they were taught in vet school to what the respondents considered to be safer practices such as ligating the broad ligament in dogs to reduce hemorrhage or avoiding using a three-clamp technique on the ovarian pedicles of dogs to help improve ligature security. Suggestions for improving support including providing more guidance to clinics on what is appropriate supervision for a new graduate, making sure the new graduate was paired with an experienced nurse, making sure an experienced veterinarian was scrubbed in with them rather than just being present in the practice, and providing opportunities for the new graduate to volunteer at high-volume shelters. Another interesting comment was that many new graduates lacked confidence in their approach because they were exposed to too many different techniques when learning from different veterinarians and were confused about best practices for performing the procedures. The survey respondent suggested providing students with a single baseline approach to use as a starting point before experimenting with other techniques.

The survey results revealed several important findings about preparing students to perform desexing surgeries competently as new graduates in clinical practice. Approximately two-thirds of respondents who had supervised veterinary students on final-year extramural rotations over the previous 12 months allowed students to perform any type of supervised desexing procedures at the practice. While it was common to allow students to perform dog neuters, cat spays, and cat neuters, relatively few allowed students to perform dog spays. The two most common reasons for not giving students more opportunities were that it took too long for them to complete the surgeries within the constraints of the busy practice schedule and that the veterinarians had concerns over the technical skills of the students in basic instrument, tissue, and suture handling, which were both seen as potential liability risks for operating on client-owned animals. Based on our personal experience teaching desexing surgeries to students,10 these are issues that can and should be addressed by having students spend more time practicing ligatures, suture patterns, and instrument handling on simulated models to achieve good proficiency well before they are allowed to operate on live animals. Other veterinary schools have already implemented surgical training programs beyond the standard curriculum,12 including having students practice ligation on hemostasis models13 and running optional clinical suturing skills laboratories.14 In general, these types of programs have been well-received by students,15 but their use relies heavily on the students’ own personal motivation to invest time in practicing these core clinical skills.

This raises interesting questions over what level of proficiency is expected of students at different stages of their training and whose responsibility it is to ensure that students meet these standards. One of the survey respondents highlighted the importance of teaching students good instrument and tissue handling practices from day 1 in the anatomy dissection laboratories to prevent bad habits from developing before the students start practicing these skills in a surgical context. This is also critical because there is often a high student-to-staff ratio in subsequent live animal surgery laboratories, which limits the amount of individual feedback that can be provided to students to help them improve their surgical techniques if there are any major issues.16 A recent paper by the American College of Veterinary Surgeons generated a list of core surgical skills expected of entry-level veterinarians—some of which require practice on live patients to master and some of which can be practiced on simulated models.17 For the latter skills, our general opinion is that it is the university’s responsibility to ensure that students have access to the basic resources they need to learn these skills, but that it is ultimately the students’ own personal responsibility to be proactive about their learning if they want to have the privilege of performing surgery on live animals as pre-clinical or final-year students. The majority of our survey respondents indicated that they would be more willing to let students perform surgeries if the students had a higher level of competence before starting final-year rosters as well as a more positive attitude toward learning while they were rotating through the practice.

The use of more formal evaluations prior to students entering final year could be beneficial, especially since there is often a mismatch between the students’ perceptions of their skills and their actual skills,18 which is known as the Dunning–Kruger effect.19 Anecdotally, we have found that this works in both directions with many highly competent students greatly underestimating their abilities and many students with poor skills greatly overestimating their abilities. This could explain why many survey respondents had low confidence in their ability to perform desexing procedures despite having performed more supervised surgeries than is typically required to achieve basic competence. One previous study found that it took an average of four dog spays before the majority were assessed as being competent,4 while another found that the average times taken by students to complete surgeries usually decreased below the reasonable expected surgery times for new graduates within five supervised surgical procedures.20 These estimates were also broadly consistent with the number of supervised surgeries our survey respondents indicated it took before they were confident letting new graduates perform the surgeries unassisted.

Providing students with more formal feedback on their current skills could help increase confidence by generating realistic views about their strengths as well as opening up discussions about ways to improve their weaknesses. In programs that use a “see one—do one—teach one” approach to learning,10 there are significant opportunities to get other students involved in assessing their peers and providing constructive feedback. It could be helpful to practices to see the specific evaluation sheets for individual students since many survey respondents indicated that one of their challenges in teaching was being able to accurately gauge students’ existing knowledge from their limited interactions during relatively short clinical placements at the practice. It is also important to note that unless students have opportunities for sustained practice over the course of their clinical year, they may lose confidence and skill by the time they graduate.21

Although many veterinarians expressed concerns over the potential for increased peri-operative complications with students and new graduates performing surgeries, these were reported as happening only rarely or occasionally. This is consistent with previous estimates of relatively low complication rates from desexing surgeries performed in a teaching hospital setting.2224 The most common concerns were over breaks in sterility and dropped pedicles during the procedures, which are sometimes difficult to predict or prevent even when the students are closely monitored.

It should be noted that encouraging students to perform incisions that are too small or to rush through surgeries may increase the risk of complication such as dropped pedicles or hemorrhage. This should be carefully considered when teaching, especially since many respondents expected that the new graduates should be able to complete the procedures relatively quickly. Several respondents also indicated in the free-text comments that another one of the reasons they did not allow students to perform desexing surgeries in clinical practice was because they were not confident in knowing how to teach or being able to fix complications if they did occur while students were performing the surgeries. Based on the authors’ own experiences with teaching surgical skills to students, it requires a significant amount of time and patience to learn how to explain the techniques in a way that makes sense to students with very different learning styles and fine-motor skills. Although there have been a few published articles about teaching surgery to novices,2527 it could be helpful for experienced surgical instructors to draft resources for practicing veterinarians about the most common problems encountered at each procedural step in the surgery as well as troubleshooting tips. Given the number of veterinary students who will end up becoming mentors in private practice or academia, it may be beneficial to include modules in the veterinary curriculum that provide guidance on teaching methods. For example, the “see one—do one—teach one” model has been found particularly effective in encouraging students to take a more active role in their own education28 and is something that could be incorporated early during the curriculum, for example, during anatomy and dissection laboratories. However, it is unlikely that simulated models or cadavers can ever fully replace the need for students to gain competence and confidence on live animal patients.

As with any voluntary cross-sectional survey, there is always the potential for the results to have been influenced by selection bias if individuals with stronger opinions about the subject were more motivated to participate. However, this may actually be beneficial in our case, since our primary objective was to identify key concerns about supervising inexperienced surgeons and to generate ideas for how to modify our current approach to teaching desexing surgical skills to better prepare students for practice. Other study limitations that should be noted were that respondents were asked to provide estimates of their experience and confidence at the time of graduation, which could be inaccurate given that the majority had already been out in practice for over 15 years. We also did not ask respondents if the surgical techniques they used to perform desexing surgeries themselves were the same as the techniques they taught to veterinary students or new graduates. For example, a veterinarian may use autoligation on the ovarian pedicle, but require inexperienced surgeons to perform encircling ligatures with suture.

It would be interesting in future studies to assess teaching techniques and how practicing veterinarians believe students should be taught.

One of the key take-home messages from our study was the need for clearer communication with both students and employers about what competencies, skill levels, and techniques are expected through each stage of the surgical learning process and then providing the resources to help struggling students achieve good proficiency so they can be confident surgeons early into their veterinary career. Tools like self-assessment checklists may be beneficial,29 but additional research is needed to evaluate the most effective strategies for motivating and support students in their training.

Note

a A language and environment for statistical computing, R Foundation for Statistical Computing (Vienna, Austria, 2016)

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