Wednesday, September 15, 2010

How to learn how to spay a dog, part 1: Basic skills

As my advisor once asked: “How many times do you want a veterinarian performing surgery on your dog to have done that procedure before?” My answer is “a thousand.” But there is a first time for everyone. How do vet students learn how to spay female dogs (a procedure that many vets will do commonly during their careers)? This is real surgery, in which you go into the animal’s body cavity. It is serious stuff and animals could potentially die. So who do we learn on? (Take a moment to think about how you would design the perfect spay learning experience. I would be curious to hear how it compares with my school’s approach.)

At my school, spay lab is scheduled at the beginning of our third year. We are given videos to watch (how to scrub in to surgery, how to suture and knot, how to induce general anesthesia, and how to perform the actual ovariohysterectomy, or spay). And our anesthesia course is front-loaded for the first few weeks. During the second week of classes, before most college students have returned to school, we have a practical exam of several of these skills.

The practical exam (which was one of the more relaxed of the exams given at my school, perhaps to balance the extreme stressfulness of the actual spay) is in four parts. This is how it goes.

Prove that you  can gown up: pretend to scrub your hands and arms, showing that you know how to hold your arms so that the dirty water doesn’t run onto the clean parts of your hands; show that you know how to crawl inside surgical gloves and gowns without contaminating yourself.

Next, pick out your tools from a massive pile of them. Be able to tell apart different hemostats (clamps) and scissors; there are lots of different kinds. Put together your “spay pack” of appropriate tools.

Next, prove that you can suture and knot. Do not panic when the surgeons ask for suture patterns that the syllabus said you didn’t have to know.

Finally, show that you know how to write a SOAP (Subjective Objective Assessment and Plan). A surgeon rattles off information about a case. You write down the physical exam findings, your assessment of the dog (what is probably going on with her? What are your rule-outs?), and your plan (what diagnostics would you do if this were your patient?).

Students who pass this exam (and so far as I know, all of us did) are theoretically ready to perform their spay. Where do the spay dogs come from? One option is to purchase dogs, usually purpose-bred animals, perform a spay and possibly some other surgeries, and terminate them at the end of that use. My school has gone a different route. We have a relationship with local area shelters; students perform their spays on shelter dogs or dogs from low income families, under the watchful eyes of surgeons to make sure that we don’t screw up. It’s not ideal; the dogs will be under general anesthesia for longer than if someone with more experience performed the surgery, and they will be more painful when they wake up, again because of our inexperience. But I think it’s the best solution there is, given the situation.

Each student is assigned a partner, and each student is assigned a dog. On the first day, one student spays one dog, while their partner performs anesthesia. On the second day, their roles switch for the other dog. Both jobs are stressful; anesthesia entails monitoring a lot of parameters, and all the little tasks are hard to do at once. Moreover, it is easier to kill a dog with anesthesia gone awry than with a surgical mistake, at least in this surgery. Small groups of students are assigned dates for spay lab throughout the semester; the entire class can’t do the lab all at once, obviously. My spay day happened recently. I’ll report on it in detail in the next posts in this series.

[How to learn how to spay a dog, part 2: Anesthesia]
[How to learn how to spay a dog, part 3: Surgery]
[How to learn how to spay a dog, addendum: uterus removal

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