gms | German Medical Science

4th InVeST – International Veterinary Simulation in Teaching Conference

14.09. - 16.09.2015, Hannover

Comparison of teaching small intestinal anastomosis suturing techniques using simulated small intestine versus cadaveric small intestine to second year veterinary students

Meeting Abstract

  • corresponding author presenting/speaker Stephanie S. Caston - Departments of Veterinary Clinical Sciences, Iowa State University, Ames, Iowa, United States
  • author Jennifer A. Schleining - Veterinary Diagnostic and Production Animal Medicine, Iowa State University, Ames, Iowa, United States
  • author Jared A. Danielson - Veterinary Pathology, Iowa State University, Ames, Iowa, United States
  • author Eric L. Reinertson - Departments of Veterinary Clinical Sciences, Iowa State University, Ames, Iowa, United States
  • author Kevin D. Kersh - Departments of Veterinary Clinical Sciences, Iowa State University, Ames, Iowa, United States

InVeST 2015: International Veterinary Simulation in Teaching Conference. Hannover, 14.-16.09.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. Doc15invest02

doi: 10.3205/15invest02, urn:nbn:de:0183-15invest027

Published: September 10, 2015

© 2015 Caston et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at



Yearly surveys of practices employing Iowa State University College of Veterinary Medicine graduates consistently rate proficiency in clinical skills as “very important” when practices are considering hiring a new associate; second only to communication skills. However, the cost of providing certain clinical skills training on live animals or tissues from live animals in the professional curriculum is becoming prohibitive. Teaching appropriate suture patterns on simulated tissue could allow students to be better prepared for the live animal experience, have more confidence when first presented with live animal surgery, and possibly reduce the number of live animals needed for the student to gain proficiency in intestinal suture placement [1]. This could directly reduce the cost of teaching surgical skills in the veterinary program as well as reduce the number of terminal animals that are currently utilized to provide learning specimens for surgical skills laboratories.

It is hypothesized that students who are trained on simulated small intestine to correctly place a Gambee suture pattern will perform as well as students who are trained in the traditional method of Gambee suture placement using cadaveric small intestine.

A random subset of veterinary students in the second year of the professional curriculum at Iowa State University College of Veterinary Medicine who are enrolled in the second year course Principles of Surgery Laboratory will be identified to participate in this study. Students may opt out of the study at any time. As part of a regularly scheduled laboratory introducing the surgical procedure of small intestinal anastomosis students will be divided into two groups: 1. Anastamosis utilizing simulated small intestinea and 2. Anastamosis utilizing the current protocol of cadaveric small intestinal tissue harvested from euthanized horses. An instructor (ELR) will demonstrate how to perform intestinal anastomosis utilizing visual training aids and verbal communication. Each student will then be released to surgery tables supplied with the appropriate small intestinal segment where they will practice the Gambee pattern to complete intestinal anastomosis while the same instructor (ELR) provides supervision of technique. Gambee pattern placement will then be assessed by blinded investigators (JAS, KDK, and SSC) in the subsequent surgery laboratory one week later utilizing a rubric developed and validated for surgical skills assessment.

Three blinded investigators, who are board-certified in surgery, will provide assessment of each student using the following criteria (Modified Global Rating Index for Technical Skills (GRITS) from [2]):

  • Respect for Tissue – Measures appropriate use of tissue handling
  • Time and Motion – Measures efficiency of suture placement and appropriate motion of instrumentation
  • Instrument Handling/Knowledge – Measures appropriate use of surgical instruments
  • Flow of Operation – Measures progression of the anastomosis procedure
  • Knowledge of Specific Procedure – Measures procedural components of small intestinal anastomosis

Inter rater reliability will be calculated using an intra-class correlation. Descriptive statistics (mean, median, standard deviation, minimum, and maximum) will be calculated for each group. Scores between groups will be compared using a Mann-Witney U test, with p < .05 used for significance testing. Analyses will be performed using IBM SPSS Version 21.

[This study will be completed by April 8, 2015 and data analysis will be completed by mid-May 2015.]

[a Small Intestine Simulator, SurgiReal Products, Inc., Fort Collins, CO]


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