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ABSTRACT
Veterinary students require deliberate practice to reach competence in surgical bovine castration, but animal
availability limits opportunities for practice. We sought to create and validate a surgical bovine castration model
consisting of a molded silicone scrotum and testicles to allow students to practice this skill without the use of
live animals. We sought to validate the model and associated scoring rubric for use in a veterinary clinical skills
course. A convenience sample of third-year veterinary students (n = 19) who had never castrated a bovine were
randomized into two groups. The traditionally trained (T) group performed castration on a live bull calf after a
50-minute instructional lecture. The model-trained (M) group received the same lecture and a 2-hour clinical
skills session practicing bovine castration using the model. All students were subsequently digitally recorded while
castrating a live bull calf. Performance recordings were scored by an investigator blinded to group. Survey data
were collected from the students and from expert veterinarians testing the model (n = 8). Feedback from both
groups was positive. The M group had higher performance scores than the T group (M group, M = 80.6; T group,
M = 68.2; p = .005). Reliability of rubric scores was adequate at .74. No difference was found in surgical time
(M group, M = 4.5 min;T group, M = 5.5 min; p = .12). Survey feedback indicated that experts and students considered
the model useful. Model training improved students’ performance scores and provided evidence for validation of
the model and rubric.
Key words: veterinary simulation, surgical bovine castration, surgical skills, clinical skills training, veterinary
students, veterinary education, model
Figure 1: Components and instruction to make the bovine castration model: (a) Silicone (Ecoflex®) was painted over panty
hose to form the scrotum; (b) latex tubing of various diameters was sheathed in plastic to form the spermatic cord; (c) silicone
(Ecoflex®) was poured into hollow plastic spheres to form the testicle and a leur lock connector was embedded into each testicle
to make it re-usable; (d) components were assembled into the scrotum; and (e) components were hung from a wooden board that
is hung at the level of the scrotum in a live bull calf
ing the scrotum on the model (excision of distal scrotum Serra emasculators to emasculate the cord on the model.
with scalpel or incision of scrotum with Newberry knife). Students in the T group received no additional training
Survey data were collected using a 5-point Likert scale before castrating a live bovine but trained with the model
(Appendix 1). Questions revolved around fidelity of the after performing a live castration.
model and perceived ability to enhance students’ learning, Three to four weeks after completing their respective
protect animal welfare, and promote safety while perform- training program, all students castrated a live bull calf
ing the procedure. Experts were asked to make positive or while being digitally recorded by an investigator with
negative written comments about the model. a hand-held video recorder (Sony Handycam HDR-
CX240, Sony Corp.). Participants were identified by a
Comparison of Student Learning Outcomes paper with a unique number held up at the start of the
A convenience sample of third-year veterinary students recording. All students were coached by an instructor
(n = 19) who had never performed a bovine castration (LM) as necessary while performing the castration on
were recruited from a class of 102 to participate in the the bull calves to protect animal welfare. The instruc-
study. Students were randomly assigned a number and tor was told to provide as little assistance as possible
divided evenly into two groups, the traditionally trained but was required to ascertain that the procedure was
(T) group and the model-trained (M) group. Before us- performed safely and correctly. Bull calves were 3- to
ing the model or performing castration of a live bull calf, 4-month-old Angus selected on the basis of weight of
all students attended a 50-minute lecture in the regular more than 100 kilograms and need for castration. Students
curriculum about castration of the bovine. All students could choose to use a scalpel or Newberry knife to incise
had been through the LMU CVM surgical skills training the scrotum after they heard a brief explanation of the
Figure 2: The bovine castration model: (a) incising the scrotum using a Newberry knife, (b) stripping fascia from the spermatic
cord, and (c) emasculating the spermatic cord
for post-operative complications by the farm manager and the scrotum hung, subsequent models could be made at
the supervising veterinarian (LM). After using the model a reset cost of $10.
and castrating a live calf, students completed a survey
retrospectively evaluating the bovine castration model Veterinarians’ Evaluation of the Model
using a 5-point Likert scale that was similar to that used All experts (eight of eight) agreed or strongly agreed that the
by practitioners (Appendix 2). final model design had adequate landmarks, felt realistic,
The digital recordings were captured in such a way as was easy to use, was suitable to give students a general
to exclude student identifiers and were edited to remove idea of the actual tactile experience when performing this
all sound. The recorded procedures were scored and timed skill, could improve animal welfare, and was safe. Most
by a single investigator (PG) blinded to group who was experts (seven of eight) agreed or strongly agreed that the
experienced in performing bovine castration and teaching model encouraged the correct steps (one neutral), would
students how to perform the procedure. Surgical time was increase students’ learning ability by first performing the
recorded from the start of the first incision to emasculation skill on the model (one neutral), and could be used to as-
of the second testicle (the moment the spermatic cord was sess whether a student was ready to progress to perform
transected). The investigator also recorded the number of live surgery (two neutrals). Comments from five of the
times the instructor physically assisted the student with experts highlighted areas for improvement, including
the procedure. The digital recordings were viewed on a the addition of more realistic gubernaculum and fascia
computer monitor, and the evaluator could pause or replay to strip (one expert), making the spermatic cord more
the recordings as needed. anatomically realistic in feel for applying the emasculators
The digital recordings were scored using a rubric that (three experts), and making sure testicles are side by side
was developed by a subset of faculty (SLA, LM) who (one expert). See Figure 3 for a graphical representation
were experienced in teaching and assessing large animal of expert survey data.
surgical skills. The items in the rubric reflected the steps Comparison of Student Learning Outcomes
for performing a castration on a live bull calf. Each item
Task-specific rubric percentage scores were lower for
was scored as unsatisfactory (0), borderline (1), good (2), or
the T group than for the M group (T group, M = 68.2%,
excellent (3). The maximum achievable rubric score was
SD = 9.8; M group, M = 80.6%, SD = 6.0; p = .005). We
36 points. Students’ scores were converted into a percentage
found no difference in any single line item rubric scores
before statistical analysis to account for any missing values.
between the T and M groups on the task-specific portion
To capture a more holistic view of the performance, two
of the rubric, except for the score for exteriorizing the
general surgical skills (tissue handling and efficiency) were
testicles, for which students who used the model first had
scored separately using a global rating scale (GRS), and an
significantly higher scores (T group, Mdn = 2, range = 1–3;
overall GRS score was independently determined. Scores
M group, Mdn = 3, range = 2–3; p = .01). Overall global
for each measure of the GRS ranged from 1 for a very poor
rating scores did not differ between groups (T group,
performance to 6 for an excellent one.
Mdn = 5, range = 4–5; M group, Mdn = 5, range = 4–5;
Statistical Analyses p > .99). Full rubric results can be seen in Table 1. Inter-
Data were analyzed with GraphPad Prism version 7.02 nal consistency of the scores generated by the 12-item
(GraphPad Software, La Jolla, CA). Categorical data rubric was .743.
(survey data, individual task scores from the rubric, The T group took an average of 5.5 minutes (SD = 2.0),
tissue handling score, efficiency score, and overall GRS and the M group took an average of 4.5 minutes (SD = 1.6)
score) were compared between control and experimental to complete the live surgery. This difference did not reach
groups using Mann–Whitney tests. A Shapiro–Wilk test statistical significance, although the effect size was me-
of normality was performed on continuous data (surgical dium (p = .12, d = 0.55; Figure 4). Students in the T group
time, number of times assisted by instructor, and task- required the instructor to physically assist with the per-
specific scores transformed into a percentage). Because formance of the surgery more often (M = 3.7, SD = 2.4)
these data were normally distributed, a t-test was used than students in the M group (M = 1.1, SD = 1.3, p = .01,
to compare data between control and experimental d = 1.35; Figure 4). We found no between-groups difference
groups. Internal consistency of rubric scores was mea- in the number of students using a Newberry knife (three
sured using Cronbach’s α. Effect sizes were calculated in the T group, one in the M group). a scalpel (p = .58).
using Cohen’s d. No serious post-operative complications (e.g., bleeding
4
Likert Scale
3
1
https://jvme.utpjournals.press/doi/pdf/10.3138/jvme.2018-0016 - Wednesday, February 23, 2022 5:37:06 PM - IP Address:201.185.104.51
0
Landmark Ease of Encouraged Tactile Increase Safety Use for
accuracy Use Correct score Learning Assessment
Steps Ability
Table 1: Summary of data obtained using the rubric during live castration of a bull calf
T group, M group,
Task Mdn (range) Mdn (range) p
1. Testicles are both located on palpation 2 (0–2) 2 (1–3) .50
2. Incision is made or bottom of the scrotum is excised; approximately 1–2 in. 2 (0–2) 2 (2–3) .72
of the base of the scrotum should be removed
3. Smooth, straight incision through all layers of the scrotum 2 (1–3) 2 (1–3) >.99
4. Proper blunt dissection through fascia to exteriorize testicles 2 (1–3) 3 (2–3) .01
5.Vaginal tunic left intact at emasculation site for closed castration (Testicle 1) 3 (1–3) 3 (2–3) .75
6. Testicular cord stripped down adequately (Testicle 1) 2 (1–3) 2 (2–3) .42
7. Safely cuts cord with the emasculators facing the correct direction (nut to 2 (2–3) 2 (2–3) >.99
nut; Testicle 1)
8. Checks cord for bleeding before returning to body (Testicle 1) 2 (1–2) 2 (1–3) .23
9.Vaginal tunic left intact at emasculation site for closed castration (Testicle 2) 3 (2–3) 3 (3–3) >.99
10. Testicular cord stripped down adequately (Testicle 2) 2 (1–3) 3 (2–3) .09
11. Safely cuts cord with the emasculators facing the correct direction (nut to 2 (1–2) 2 (1–3) .64
nut; Testicle 2)
12. Checks cord for bleeding before returning to body 2 (1–3) 2 (2–3) .10
Total checklist score, %, M (SD) 68.22 (9.8) 80.6 (6.0) .005
13. Tissue handling 5 (3–5) 5 (4–6) .49
14. Efficiency of time and motion 4 (3–5) 5 (4–5) .12
15. Overall GRS 5 (4–5) 5 (4–5) >.99
Note: Scale for tasks 1–12: unsatisfactory (0), borderline (1), good (2), and excellent (3), Scale for scores 13–15: very poor (1), poor (2), borderline
unsatisfactory (3), borderline satisfactory (4), good (5), and excellent (6), Significant values are in boldface.
GRS = global rating scale
Figure 4: (a) Surgical time for students performing castration on bull calves and (b) number of times the instructor assisted the
student during the surgical procedure
Note: Bar represents the mean
4
Likert Scale
0
Landmark Ease of Encouraged Tactile Increase Safety
accuracy Use Correct score Learning
Steps Ability
a clinical skills laboratory in which the bovine castration cattle is equivalent to 100 minutes of lost production. Given
model was used had higher task-specific rubric scores and that the most common type of castration a veterinarian may
required less assistance from the instructor during their be involved with in beef production is surgical castration,6
first live castration of a bull calf. The use of models to it is imperative that veterinary graduates be prepared to
teach invasive procedures is driven by the ethical concept perform this skill efficiently.
of the three Rs in animal use: reduce, refine, and replace.24 Scores generated by the task-specific rubric demonstrated
Improving students’ skill level before proceeding to live acceptable reliability. A single checklist item, evaluating the
animal practice demonstrates the concept of refinement. ability of the students to exteriorize the testicles on incision
The global score given for each student’s performance of the scrotum, was significantly higher in model-trained
did not differ significantly between groups, perhaps be- students. A potential reason for this finding is that students
cause of the small sample size and lesser statistical power had learned from the model that the testicles should be-
of non-parametric tests. Both checklists and global rating come exteriorized after incision of the scrotum. In addition,
scales have proven to be valid and reliable means of as- students may have been more comfortable using the instru-
sessing student performance.25 We also did not detect a ments to cut the scrotum, creating a better quality incision
significant difference in surgical times between student that facilitates exteriorization of the testicles. These results
groups, although training with the model before performing present the question as to whether the ability to strip the
live castration had a medium effect size on the time it took fascia surrounding the testicle is necessary in the model
to perform the procedure. A larger study, ideally one that design. This step was consistently identified as requir-
included students from several veterinary schools, would ing improvement in model design by veterinary experts;
be required to better define the impact of model training however, based on the student data, perhaps refining the
on duration of the procedure. In a beef production setting, model to better mimic this skill is unnecessary, and it has
even a difference of 1 minute per bull calf over 100 head of not been pursued as a model revision to date.
Veterinary Medicine, College of Veterinary Medicine, Lincoln 10. I have concerns that this model could teach students
Memorial University, 6965 Cumberland Gap Parkway, Harrogate, poor technique.
TN 37752 USA. Email: Gilbert.Patterson@lmunet.edu. His
research interests include veterinary education, public health, and Please make any positive or negative comments about
agricultural development. the model below.