November 28, 2016

(Dr. Dan Thomson) Hey folks, welcome to the show, thanks for joining us! Today’s gonna be a fun one. We’re going to be in the Clinical Skills Simulator at Iowa State University’s College of Veterinary Medicine with Dr. Frank Cerfogli. We’re gonna show you a lot of different things today about how vet students are learning how to do suture patterns and put in IVs. Hope you enjoy it!

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(Dr. Dan) Hey folks, here we are in the Clinical Skills Laboratory. Dr. Frank Cerfogli is a veterinarian that teaches here at Iowa State University, teaches veterinary students first, second and third year here in the Clinical Skills. (Dr. Frank Cerfogli) Yes, and even fourth year. (Dr. Dan) And even fourth year. Another person that went to veterinary school with me and has sworn to secrecy on both counts. Now, what we are going to go through is talk a little it about some of the clinical skills that you teach because this is just amazing. Wish they would have had this when we went through veterinary school. (Dr. Frank) It seriously is new to Iowa State. In the past year we started January of 2016. I maybe had 30 students walk in the door January, and now, eight months, nine months, 10 months into it, I have 240 to 410 students walk through the door on a monthly basis to come in and do skills. (Dr. Dan) It’s like a way to learn how to be a veterinarian and do this without maybe some of the negative implications of, whether it’s caseload or doing it on an animal in a research setting? (Dr. Frank) Correct. This current setting, no animals, just simulations. Also, in this setting, I have no grades. The students come down, they are asked to do the skill, I can be a dove some days, I can be a hawk others and that particular skill, whatever it is, I make sure that they don’t leave until they’ve gotten it or they keep coming back until its accomplished. (Dr. Dan) I liken it to someone that’s a basketball player or something, you need a place to work out, a place to lift weights, a place to shoot baskets and things to that nature, right? Veterinarians probably ought to have those, not just learn it from a book. (Dr. Frank) Yes. The skills gym. (Dr. Dan) This is the skills gym. (Dr. Frank) I might put the sign up now. (Dr. Dan) All right, let’s do it. Let’s see what you got here. (Dr. Frank) Well, one first thing that we do now for a first year students, we did this approaching second year labs, but now we’re doing knot tying boards for the first year students. The students come in — I’m sorry, I don’t have any Kansas State ones here, but I got a whole lot of ISU Cardinal and Gold. (Dr. Dan) That’s all right. I’m alumni. I’m fine with Cardinal and Gold. (Dr. Frank) We’ll teach those students what the difference is when they get these knots thrown. Whether they’re throwing good square knots or whether they’re throwing granny knots. I can show them how one knot is superior to the next. A lot of students come in here and they’re tying high. When they’re tie high, they leave a strand high, as they tighten it, there’s going to be a slipknot. They’re going to have both of these strands parallel to the table in order to get a good square knot in. (Dr. Dan) That’s awesome. (Dr. Frank) We also have placed in the first year students’ hand, a needle-holder and then a paracord, which is our first year suture. Then we are showing the students how to come in here and go around a pedicle to ligate an artery or vein. They are going to have confidence now that I can’t get this apart when they’re doing it, that they’ll have the same product in the animal. (Dr. Dan) The first year basically is some skill on suturing, knot tying and ligating? (Dr. Frank) Correct. (Dr. Dan) You also ran me through the palpation where they have puzzles and Legos and things and you learn how to put them and they get you to start having that dexterity then of not being able to see and how to get it done. (Dr. Frank) That’s Correct. (Dr. Dan) Let’s take a break. We’re going to — While we take the break then while you are all at commercial, we’re going to move from the first year to the second year of veterinary school. It’s takes a little bit longer in real life, but Dr. Frank Cerfogli is here with us, thanks for joining us.

(Dr. Dan) Folks, welcome back to the show, thanks for watching us today. Dr. Frank Cerfogli here at Iowa State University, we are in the Clinical Skills Lab that he runs here and it’s just amazing. If they’d had this when we were in vet school, right? (Dr. Frank) Me too, exactly. (Dr. Dan) Geez Louise, this is something else. This is the second year lab. Walk me through some of the different things that you have here and that you are able to simulate for the veterinary students. (Dr. Frank) Well, initially what the students did a lot of times when they wanted to learn how to suture, is they went to the refrigerator and got the rotten banana and a rotten orange. Now, today, all the different levels of synthetics that they make, whether it’s urethane or silicone, we can produce a model that is very realistic and has all layers so as we cut through this, this, of course came intact. As we cut through the skin, we have all layers, we’ll have skin, and we’ll have a subq layer, and we’ll have this very dense connective tissue in the mid-line of the abdomen. This is where you first learned of this external rectus sheath or linea alba, has a very nice area of distinct anatomy that you want to focus on, so that you’re always going into the abdomen at an appropriate approach. Well now, the student has done that and they can also close. Now, they’re going to close up these three layers on this particular model. They’re going to close the external rectus sheath or linea alba. They’re going to close the subq, and then, they’re going to close the skin, have an appropriate closure. We have different colors, different textures. There’s three layer, there’s five layer, there’s even some that will bleed. [Laughter] As we go through them, there’s a company with, what they’ve referred to as Real-flow Technology, they will, some of these models will bleed. We also have internal organs besides skin, right? Then we’re in there doing an abdominal exploratory, we decide we need to open the bladder, or need to open the uterus, or open the stomach and intestine. These are all various versions of that. We have a model that’s mostly urethane rubber. We have silicone rubber. We have foam, and it’s probably the first type out, right? (Dr. Dan) Yes. They get started and then practice on that, and then move to this — this is amazing. (Dr. Frank) It’s very realistic and as you open it up, it has a real feel, real look. Believe it or not one thing that I used to make it even more realistic is baby powder or talcum powder, and that makes it slippery, so you wouldn’t think that it would, but it relieves all of that tackiness and then makes this particular organ and this model in particular slippery, just as the real deal. (Dr. Dan) So you have different incisions here, you have resection and anastomosis. (Dr. Frank) Sure. We have a resection and anastomosis. This is where we’re going to take two pieces end on, and maybe we’ve removed them. What you’re going to do- (Dr. Dan) Sometimes when you go in and you take out a piece of intestine, and then you have to reconnect. (Dr. Frank) Sure. This is an anastomosis end to end, whereas this type, or maybe we just had to take out a tennis ball or a golf ball, whatever that dog had ingested. (Dr. Dan) Or super ball. (Dr. Frank) Yeah, he woofed it down and now I’ve got to — now it’s my responsibility. Then this would be something that we referred to as a gastrostomy or enterotomy. (Dr. Dan) Awesome, you even have the one here where you’ve done the Utrecht pattern like a uterus when you do a C-section. (Dr. Frank) Sure, if they wanted to feel, pretend this was the bladder, is the bladder. If they want to pretend that it’s the stomach, it’s the stomach. These are homemade versions that I’ve just come up with here. If they wanted to close the uterus, this is the Utrecht pattern for the closure of the uterus. (Dan) All right. Well, folks we’ve made it through the second year, we’re headed to the third year. Thanks for watching DocTalk. Dr. Dan Thomson and Dr. Frank Cerfogli. More after these messages.

(Dr. Dan) Folks welcome back to DocTalk. Dr. Dan Thomson with Dr. Frank Cerfogli. We’re in the Clinical Skills Laboratory at Iowa State University’s College of Veterinary Medicine, where Dr. Cerfogli teaches students on a day-to-day basis these clinical skills using models, which is just phenomenal. (Dr. Frank) They’re very realistic. (Dr. Dan) Oh my gosh. (Dr. Frank) There are low fidelity models as they say, and high fidelity models, and we’re trying to get more and more high fidelity models as long as they’re reasonable. This one in particular is a canine catheterization model. We have a vein here that you can see it’s clear transparent, and then, the canine limb is darker. But as the student can now actually feel this without skin. I’ve taken it to the next step and I put the skin on, and that’s still there, and underneath there they’ll be able to isolate that vein, they could cut down to it if they needed to, or they can place the catheter in it with the skin on just as if it would have that feeling or palpation in a real dog. (Dr. Dan) There’s a few people that have taken my blood that could have used this model and practice instead of practicing on me. [Laughs] All right. We have these models, and then, this is unbelievable. (Dr. Frank) Yes. This is an abdominal exploratory model, and this is third year. We’re teaching the students how to put in an IV catheter; therefore they would be able to deliver the animal’s anesthesia. Then building on that besides the anesthesia and putting them and placing them under general anesthesia, we’re going to actually do the full surgery and in particular on dogs and cats. A tried and true procedure for all veterinarians to have to learn as the day one skill is the ovariohysterectomy, so the hysterectomy – (Dr. Dan) How to spay a dog. (Dr. Frank) – removal of the uterus and the ovaries in the dog and cat. Sometimes that’s very beneficial that your cat is not bothering you every month, all throughout summer – (Dr. Dan) Exactly. (Dr. Frank) – and the dogs twice a year, they’re just going to stop. (Dr. Dan) Or having kittens. [Laughs] (Dr. Frank) Yes. They’re just going to stop cycling. This is a particular model. It’s a fairly high fidelity. It’s all silicon, but I have an abdomen with the skin and again, those real layers of skin that I go through. We have an omentum, an intestine, have a bladder. I have kidneys, spleen and in here I can teach the students, as they go through this body wall, and they feel for things that we’re looking for to identify where the ovaries are in the animal, where the uterus is in the animal. And then, in this particular one, the student can actually do the surgery and take out a completely synthetic, silicone uterus and ovaries. This is the insert, so of course it looks a little bit different than it’s in the model, but we have the ligaments necessary to break down, and we have all artery, a red piece of thread here in there to simulate that artery and vein. And then, how I can tell — now I can tell that the student did it successful, that all the part components have been removed. I can go back in and I can inspect that they did a double ligation on this artery and vein that they did a double ligation on this artery and vein, and then they also have done that for the uterine body. (Dr. Dan) Absolutely incredible. Lots of different things. I can’t imagine what’s going to be like in 10 years. (Dr. Frank) Yes. I think they’re going to have a 3-D print the dog. (Dr. Dan) [Laughs] Well, folks we’re going to take a break. We’re going to come back with a wrap up here in the Clinical Skills Lab with Dr. Frank Cerfogli here at Iowa State University. Thanks for joining us. More to come.

(Dr. Dan) Hey folks, welcome back to DocTalk. I’m Dr. Dan Thomson here with my friend and colleague Dr. Frank Cerfogli. We’re in Iowa State University in the Clinical Skills Laboratory, which is just a phenomenal laboratory and environment for teaching future veterinarians. What in the heck? (Dr. Frank) This is Petunia and she happens to be a model as created to help students learn how to do jugular venipuncture, draw blood on alpacas. (Dr. Dan) I could’ve used that. (Dr. Frank) Camels, llamas, all the above. That’s going to be very similar, but of course this reduces student’s anxiety. In this model and all the other models that I showed you today are component of helping students learn in a stress-free environment and then there’s no grades attached, and then a lot more learning that I feel happens. (Dr. Dan) And there’s no client breathing over the top of you. It’s an opportunity to really learn and gain confidence. (Dr. Frank) Yes. I encourage mistakes, right? It’s like, “Let’s fail as many times as we can today, so that when it counts we get it right”. (Dr. Dan) Yes. Just in general, I mean the philosophy — what do you see in the students when they come in here and — I mean, they’ve got to be excited. (Dr. Frank) I think the students are excited. I think clinicians are excited. I think the clinicians are all the time come to me with crazy ideas, “Let’s build the next model, let’s make the next simulation”, because they want to add something for their students in this particular laboratory. (Dr. Dan) It’s something they have in their hands before they get to the clinic. (Dr. Frank) Yes. Some of it is definitely preparatory for when they have them as a student or for their next class. (Dr. Dan) Now this doesn’t just happen for free. This is something that obviously with the amount of equipment, you say you got more coming? (Dr. Frank) Yes. We have euthanasia simulators. We have a full colic simulator. We have a bovine therio, I know you saw Frosty today and you’ve done some calf simulations of your own with your own equipment, but we’re going to have a full bovine therio unit that has a palpation in it, there’s a 45-day, 60-day, 90-day pregnancy, along with an open heifer, and an open calf. (Dr. Dan) All these within simulation and to be able to just teach and have open opportunities, you know folks. This is an opportunity that Iowa State University has seized, that they’re moving forward in in veterinary medicine, Dr. Schleining, Dr. Cerfogli are helping push this type of initiative forward. They say that there’s a fundraising arm going on now. (Dr. Frank) Correct. Iowa State as a whole has fundraising campaign for foundation and then the College of Veterinary Medicine makes their own individual goals as well. Some of those goals in particular are going to be to help out the Clinical Skills Lab. (Dr. Dan) If you feel the need to step up and you want to help future veterinarians, check with Iowa State. I’m sure that they would take a donation towards the Clinical Skills Laboratory. (Dr. Frank) I definitely have projects in mind. (Dr. Thomson) [Laughs] Well, thanks for spending time with us today. Thank you for watching DocTalk. Remember, always work with your local veterinarian and if you want to know more about what we do on the show, you can find this at I’m Dr. Dan Thomson with Dr. Frank’s Cerfogli. We’re from Iowa State University and I’ll see you down the road.

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