S. C. DeMasi1, E. Katsuta1, K. Takabe1 1Virginia Commonwealth University School Of Medicine And Massey Cancer Center,Division Of Surgical Oncology, Department Of Surgery,Richmond, VA, USA
Introduction: Traditionally, exposure to surgery to preclinical medical students has been remarkably limited which leads to an unfair, negative connotation towards the specialty. Restriction is not only limited in time, but also to learning in the operating room. Use of alive animals for training preclinical medical students has been a topic of debate, from animal protection and cost stand point. Use of an alive porcine model was reported to most closely prepare the medical students for the anxiety and perioperative demands required in the OR, with most students reporting that it was an imperative part of their education. On the other hand, porcine operations are widely expensive. Therefore, we hypothesize that even small animal (murine) models will be a vital component of training preclinical medical education.
Methods: Murine breast cancer E0771 cells were orthotopically implanted in female Blk/6 mice to generate breast tumor. A radical mastectomy, defined as the surgical removal of the tumor with surrounding skin and pectoralis major muscle, was performed on Female C57Blk6 mice of various ages. Wound parameters, time to complete procedure, number of sutures per minute, and weight of tissue removed, were recorded.
Results: Improvement of surgical skills was observed in all parameters we recorded. Wound closure was successful in all widths attempted from 0.5cm to 1.5cm. The number of stitches per minute nearly doubled after only 6 wound closure experiences. The time required to complete the radical mastectomy procedure decreased by almost half by the 9th case. Finally, the appropriate stitch interval of 2-3mm was ascertained after the 5th wound closure. Notably a single animal died immediately after the operation, which was found due to inappropriate anesthesia management during the removal of a large tumor, which was contrary to the anticipation that death can occur by inexperienced surgical skills such as failure to control bleeding or unable to close the wound. However, it was the lack of understanding of the overall operative environment that actually resulted in the death of the animal. This highlights the importance of preclinical medical students being exposed to an environment that resembles the stress and responsibility that the OR demands, where a life is at stake, even if it is an animal’s.
Conclusion: The animal model to train preclinical medical students provides an invaluable learning experience, not only to improve surgical skills, but also to realize the importance of overall operative care, such as anesthesia management, even in small animals. Learning surgical techniques in an environment that can simultaneously teach medical students ‘what is essential to maintain life in the OR’, will without question improve preclinical medical education, in addition to positively shifting the attitudes of medical students towards the field of surgery.