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Integrated Surgical Training: Academia and Shelters
Lynetta Freeman, Purdue University Monica Neal, PetSmart Charities March 10, 2013
Agenda
• Benefits • Shelter context • Veterinary college
context • Purdue’s program • Other models • Funding • Questions
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Insert photo: Surgery
Habit 4: Think Win-Win*
Need for spaying & neutering
shelter animals
Need for teaching
basic surgical skills to veterinary
students
*From Stephen R. Covey: The 7 Habits of Highly Effective People
Benefits
• More pets adopted
• Allies
• Competitive advantage
• Respect
• Readiness • Respect
• Experience • Social
awareness
Students Profession
Community CVM
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Pet Overpopulation in the US
• Experts believe that there are about the same number of un-owned animals as owned – i.e. about 78.2 million
dogs & 86.5 million cats
• Cat – 2 litters/year x 4-6 kittens (12, 66, 2021, 3822, 12,680)
• Dog – 1 litter/year x 4-6 puppies
One way to limit overpopulation is by spaying and neutering animals that are adopted from shelters.
The Unmet Need
• Between 4 and 7 million animals are presented to animal shelters every year* – <2% of cats & 15-20% of
dogs are returned to their owners
– 60% of dogs and 70% of cats are ultimately euthanized
*Data from ASPCA
Challenge for Shelters
• To manage the number of animals that are presented for care with a limited budget
Purdue College of Veterinary Medicine
• Students perform spays and neuters on (1-3) shelter animals during their third year
• 4th year students perform (0-2) spays and neuters on client-owned animals
Unmet Need in Veterinary Education
• Students must have entry-level proficiencies when they graduate – Spays and neuters are the most commonly
performed procedures in veterinary medicineŦ,^
• Challenges in Veterinary Colleges
– Class size and case load – Budget, regulatory & animal welfare concerns – Balancing teaching, research, and service
*JAVMA 2012 240:1345-1354; ŦJAVMA 2004 224:1780-1787; ^J Vet Med Educ 2008 35:26-30.
Surgical Skills
• A recent survey identified 21 surgical skills where proficiency is expected of entry-level graduates*
*JAVMA 240(11):1345-1354, 2012
Benefits of Shelter Teaching*
• Students are able to practice clinical skills such as physical examination, venipuncture, administration & monitoring of anesthesia, and surgical skills in a less “intense” environment
• Students become aware of shelter issues & are more likely to volunteer to assist upon graduation
*J Vet Med Educ. 2008 35(1):26-30; J Vet Med Educ. 2008 35(4):553-8; J Vet Med Educ. 2008 35(4):637-40
Process of development
• Administration • Faculty • Students • Other
Internal
• Shelters • Veterinary community • Sponsors/Donors • Benchmarking
External
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• Pilot Study at Almost Home Humane Society
• Benchmarking – Rural Area
Veterinary Service (RAVS)
• North Dakota
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Habit 5: Seek First to Understand, Then to be Understood*
*From Stephen R. Covey: The 7 Habits of Highly Effective People
Our Inspiration
• The Mississippi State University Mobile Veterinary Clinic – 38 foot gooseneck trailer – On road 4 days/week • Staffed w/ 1 faculty, 1 shelter
med resident, 1 veterinary technician
• 3 students • 2 part-time students who
clean & restock the trailer each night
Further Understanding…
• Humane Alliance – Asheville, NC
• VIDA
• SPOT
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Habit 5: Seek First to Understand, Then to be Understood*
• Administration • Faculty • Students • Donors • Veterinarians • Alumni
16 *From Stephen R. Covey: The 7 Habits of Highly Effective People
Habit #6: Synergize*
• Support from Development Office
• Sponsors/ Donors • Hospital Support • Veterinary
Community
17 *From Stephen R. Covey: The 7 Habits of Highly Effective People
University Support
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Key Hires
• Strong interest in teaching, clinical service and shelter medicine
• Maintain relationships with shelters
• “great passion for those we serve”
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Working with Shelters
• When to engage • How to engage • Shelter selection • Maintaining
relationships • Purdue Fall
Conference sessions
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Working with Shelters
We Provide • Elective spays and neuters • Records that document
what was done • On-site training for shelter
teams: – Selection of animals for
surgery – Immediate postoperative
recovery – Follow-up care
They Provide • Healthy animals • A prioritized list • A recovery team in a safe
area • Electrical outlet • Lunch • Follow-up care
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Purdue University
Rotation (elective): • 3 weeks (8 days of surgery) • 42-68 4th year students/year • 74 surgeries/student (avg.)
Partners: • 12 shelters within 100 -mile radius 23
Costs: Purdue University
Start-up Trailer, truck, clinic equipment, build-out and installation, including initial stock of consumable supplies: ̴$370K Sources: •Grants •In-kind product support •University
Operations Clinician, technician, supplies, vehicle: ̴$ 32.5K per month Sources: •Grants •In-kind
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• Follow protocols for surgical procedures taught by Humane Alliance (Ashville, NC)
• ASV medical care guidelines for spay-neuter programs*
• Operate under PVTH hospital guidance
• Offer spay and neuter surgical procedures, other procedures at discretion of attending veterinarian
• Shelters only pay for lunch, or food & lodging for overnight trips
Serving Local Shelters
*JAVMA 2008, 223:74-96.
Documenting Impact
• We must demonstrate impact: – On the students – In the communities
we serve
Documenting Impact*
*unpublished data from 21 students performing adult canine and feline OHE, 2012
Mean Surgical Time for Sequentially Performed Procedures
Documenting Impact*
*unpublished data from 21 students performing adult canine and feline OHE, 2012
Mean Surgical Time for Sequentially Performed Procedures
Documenting Impact*
*unpublished data from 21 students performing adult canine and feline OHE, 2012
Mean Surgical Time for Sequentially Performed Procedures
What the Students LIKE
• “having the stress of being responsible, but also having the safety net of an experienced teacher available at all times”
• “learning different techniques for performing spays and neuters.”
• “learning from an “error” and figuring out how to overcome it”
• “exposure to shelters” and “recognizing how important this program is to them”
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DVM Response “Priority 4 Paws has relieved some of the financial burden on
our clinic by decreasing the number of at or below cost sterilizations, while still encouraging new adoptions to visit
a veterinarian … This is a win-win situation. I am glad Purdue is giving its students the opportunity to gain
surgical experience. In my experience, veterinary school was a controlled environment that gave me the freedom to make mistakes but I was not always given the opportunity
to ‘hold the scalpel’ in the teaching hospital. Allowing students to practice on shelter animals gives the
students experience and makes the animals more adoptable to the public. Priority 4 Paws will produce
Purdue graduates who will be more confident to serve the people and pets of Indiana.”
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Our Challenge
• To provide a source of
continuing funding for this work – Endowed Chair in
Shelter Medicine & Surgery
– Endowment for continuing operating budget
– Challenge gifts with matching funds
Models
Mobile unit CVM
Shelter HQHVSN clinic
Location of surgeries
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Model selection: Intersection between agencies and CVM
Animal welfare organizations • Number of animals • Availability of patients < 5
months • Logistical ease • Cash or in-kind resources • Willingness to address any
challenges
CVM • Availability of space • Infrastructure for record-
keeping • Logistical ease • Cash or in-kind resources • Willingness to support
procedures for robust volume
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Shelter: Texas A&M University Shelter Rotation
Rotation (required):
•2 weeks (4 days of surgery) •130 4th year students/year •20-30 surgeries/student (avg.) Partner:
•Houston SPCA (about 90 miles from campus)
Other examples: Oregon State University The Ohio State University Tufts University* Others in development
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Being launched in May 2013
Costs: Texas A&M University
Start-up capital Clinic equipment: ̴$90K Sources: •Grants •Houston SPCA
Operations Clinician, technician, supplies, housing for students: ̴$218K per year (not including shelter costs) Sources: •Grants •Alumni & major gifts •Houston SPCA
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CVM: University of Florida Merial Shelter Medicine Clerkship
Rotation (elective):
•2 weeks (6 days of surgery) •125 3rd & 4th year students/year •22-25 surgeries/student (avg.)
Partners:
•4 shelters and 6 rescue groups in the area 38
Costs: University of Florida
Start-up capital Clinic equipment: ̴$85K + substantial amount of re-cycled equipment Sources: •Merial •Private donations •University – capital and in-kind
Operations Instructors, technicians, supplies: ̴$394K per year Sources: •Grants •University •In-kind supplies •Shelters and rescue groups pay $20-$75 per surgery for adults
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HQHVSN Clinic: Louisiana State University Spay/Neuter Rotation
Rotation (elective): •2 weeks (8 days of surgery) •40 3rd & 4th year students/year •46 surgeries/student (avg.)
“When the Class of 2014 did their scheduling during the fall of 2012, the Spay/Neuter Rotation was the most requested elective.”
Partners: •Baton Rouge Spay/Neuter - high-quality, high-volume spay/neuter clinic, mentored by Humane Alliance •7 shelters and rescue groups using clinic for pre-adoption surgeries
Other examples: None, although externships available at Humane Alliance and at individual clinics
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Costs: Louisiana State University
Start-up capital $0 – already owned by the spay/neuter clinic Sources: •In-kind by the clinic (funded by earlier grants while clinic was starting up)
Operations Clinician, technician, supplies: ̴$150K per year Sources: •Grants •University •Clinic fees paid by the rescue groups and shelters
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Funding from PetSmart Charities
• Primary objective: To increase hands-on spay/neuter training offered by CVMs, including pediatric, to ensure pre-adoption sterilization
• $3M paid + committed to date across 9 schools • 6 schools in discussion • Grants: Have ranged from $20K to $250K
– Equipment and/or operations – Higher amounts for higher number of surgeries – Renewable – Non-project overhead limited to no more than 10%
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Important resources Humane Alliance www.humanealliance.org Pediatric spay/neuter video Externships and CEUs Association of Shelter Veterinarians www.sheltervet.org Spay/neuter task force Spay/neuter guidelines published in JAVMA
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Presenters
Lynetta Freeman, DVM, MS, MBA, ACVS Associate Professor, Small Animal Surgery &
Biomedical Engineering Purdue University
Monica Neal Program Manager PetSmart Charities®
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