Article on Alternatives in Education Published in JAVMA

Escrito por Nuria Querol i Viñas.

The article below, "Systematic Review of Comparative Studies Examining Alternatives to the Harmful Use of Animals in Biomedical Education," was published in the Journal of the American Veterinary Medical Association, January 1, 2007 issue. The comparison of review articles on alternatives to harming or killing animals in veterinary medical education was written by Gary Patronek, VMD, and Annette Rauch, DVM, both of Tufts University Cummings School of Veterinary Medicine. The article was initiated by AVAR after inquiring with Tufts about the issue and discussing further need to perform a review of the information.

Article on Alternatives in Education Published in JAVMA

 
The article below, "Systematic Review of Comparative Studies Examining Alternatives to the Harmful Use of Animals in Biomedical Education," was published in the Journal of the American Veterinary Medical Association, January 1, 2007 issue. The comparison of review articles on alternatives to harming or killing animals in veterinary medical education was written by Gary Patronek, VMD, and Annette Rauch, DVM, both of Tufts University Cummings School of Veterinary Medicine. The article was initiated by AVAR after inquiring with Tufts about the issue and discussing further need to perform a review of the information.
Please write a letter to the editor to the Journal of the American Veterinary Medical Association (via email to JournalLetters@avma.org or fax to (847) 925-9329) and mention that:
*  many U.S. veterinary schools have adopted humane alternatives and continue to make positive changes to their curricula.
*  more than half of U.S. veterinary schools no longer require terminal surgeries, and many do not require them in elective courses.
*  many animals are in need of veterinary medical treatment, thereby creating an opportunity for veterinary medical students to help them and, at the same time, become more proficient in their skills.
*  as noted in the article, using alternatives to harming or killing animals is more cost-efficient.
*  veterinary training should reinforce compassion for animals by using non-harmful training methods.
* students who train to become human doctors do not harm their patients during their training. Veterinary medical training should reflect the same respect for their patients.    

Systematic review of comparative studies examining alternatives to the harmful use of animals in biomedical education

Gary J. Patronek, VMD, PhD, and Annette Rauch, DVM, MS
JAVMA, Vol. 230, No. 1, January 1, 2007
Pages 37-40
Objective.To systematically review the published literature for controlled studies comparinglearning outcomes of traditional methods that require the terminal use of animals (eg,dissection, live-animal surgery, and live-animal laboratory demonstrations) with outcomesobtained with alternative teaching methods.
Design.Systematic review.
Study Population.Controlled studies published between 1996 and 2004.
Procedures.PubMed was searched with the following keywords, used alone and in combination:educational alternatives, nonlethal teaching methods, veterinary alternatives,medical education, and nonterminal animal use. Cited references of retrieved reports werereviewed to identify additional reports. Reports were selected for review only if a comparisongroup was included.
Results.17 studies that were randomized controlled trials or nonrandomized trials thatincluded a comparison group were identified. Five involved veterinary students, 3 involvedmedical students, 6 involved university undergraduate students, and 3 involved high schoolbiology students. Sample size ranged from 14 to 283 students. Eleven studies appeared tobe randomized, parallel-group trials, 4 involved comparative groups to which participantswere not randomly assigned or for which the randomization process was not clear, 1 was a2-period crossover study, and 1 involved a retrospective review of grades. In all 17 studiesreviewed, results associated with the alternative method of instruction were not signifi-cantly different from or superior to results associated with the conventional method.
Conclusions and Clinical Relevance.Although the number of controlled studies identi-fied was small, the results seem to support more widespread adoption of alternative teachingmethods in biomedical education. (J Am Vet Med Assoc 2007;230:37–43)

Prior to the late 1970s, the terminal use of animals in biomedical education was routine. By the mid

1980s, however, objections to the use of animals for this purpose began to arise, reflecting the overall change in social attitudes towards animals. Veterinary medicine has been at the center of this debate from its early days,1-4 with an increasing number of schools and colleges of veterinary medicine eliminating, reducing, modifying, or replacing educational experiences that involve euthanasia of animals or pain.5-8 As an example, at least 8 schools and colleges of veterinary medicine in the United States have established programs whereby clients can donate the bodies of their animals for use in anatomic and surgical training programs,8 reducing or eliminating the need to obtain purposebred animals for these programs. In contrast, it is difficult to gauge the degree to which alternatives to the terminal use of animals have been incorporated into undergraduate, high school, and middle school educational programs.
The primary objections to the terminal use of animals in biomedical education include a belief that it is ethically wrong to kill healthy animals for educational purposes5,9 and a conviction that medical and surgical skills can be obtained without such use of animals.6,10 It has also been suggested that the terminal use of animals could lead to decreased sensitivity among professional students11 and to a sense of irreverence for life.10,12 In addition, some have considered the use of animals from particular sources (eg, shelter animals, animals obtained from the racing industry, and purpose-bred animals) to be ethically unacceptable. Finally, there are concerns about the effect on biodiversity and species survival when large numbers of animals, such as frogs, are indiscriminately collected from the wild. The latter is not an unimportant concern, given that in 2000, 9 million vertebrate animals were used for biomedical education in the United States, with the number of invertebrate animals used thought to be equal to the number of vertebrate animals.13

Apart from ethical concerns, it has been noted that some medical and graduate students have a strong emotional response to seeing, for the first time, an animal immobilized under anesthesia in preparation for an invasive procedure. Some students have described this experience as “shocking,” and this emotional response detracts from learning, even in the presence of excellent teaching.14 There are also economic and logistic considerations associated with the use of live animals in training programs, particularly because such programs require extensive close supervision by professional faculty, whereas alternatives, such as computer simulations, require less faculty input, putting less pressure on faculty time and budgets. Several reports14,15 have documented time and cost savings when nonanimal alternatives were implemented.
The advantages and disadvantages of alternatives to the terminal use of animals in biomedical education have been widely discussed. Deeply held opinions about the essential elements of biomedical education and about what constitutes appropriate use of animals, along with the personal experiences of faculty members and the perception that accepting alternatives in education may suggest that other uses of animals are equally inappropriate, all influence how individual students, faculty members, administrators, and institutions have approached the issue.
The range of alternatives to the terminal use of animals in biomedical research is currently quite large.16-19 However, despite the passionate arguments and strongly held opinions by advocates on both sides of the issue, there has been surprisingly little focus on the actual learning outcomes achieved when alternatives replace conventional teaching methods. The purpose of the study reported here, therefore, was to systematically review the published literature for controlled studies comparing learning outcomes of traditional methods that require the terminal use of animals (eg, dissection, live-animal surgery, and live-animal laboratory demonstrations) with outcomes obtained with alternative teaching methods (eg, interactive videodisk or computer-based simulation, surgical models, and ethically sourced cadavers).
Studies involving any area of biomedical education from secondary school through postprofessional training were considered.

Methods

Published reports for inclusion in the present study were identified by searching archival materials maintained by the Center for Animals and Public Policy at the Cummings School of Veterinary Medicine and an unpublished bibliographya of studies of student performance. In addition, PubMed was searched for articles published between 1966 and 2004 with the following keywords, used alone and in combination: educational alternatives, nonlethal teaching methods, veterinary alternatives, medical education, and nonterminal animal use. Cited references of retrieved reports were reviewed to identify additional reports. Published reports were included in the present study only if a comparison group was included.

Results

Studies retrieved
­The systematic review process yielded 17 studies that were either randomized controlled trials or nonrandomized trials that included a comparison group. Five of the 17 studies involved veterinary students,20-24 3 involved medical students,14,25,26 6 involved university undergraduate students,27-30,b,c and 3 involved high school biology students.31-33 Two studies were reported only in abstract formb,c; the remainder were full manuscripts. Sample size ranged from 14 to 283 students.
Eleven of the studies appeared to be randomized, parallel-group trials,20-25,27,30-32,c 4 involved comparative
groups to which participants were not randomly assigned or for which the randomization process was not clear,26,28,29,33 1 was a 2-period crossover study,14 and 1 involved a retrospective review of grades.b
 

Types of alternatives studied­

A wide range of alternatives were compared with traditional animal-based instructional methods (Appendix). The studies involving veterinary students included a study of intestinal anastomosis performed on cadavers versus anesthetized dogs,20 a comparison of an interactive videodisk simulation versus a live animal demonstration or participation laboratory,21 studies of surgical training with animal models versus anesthetized dogs22 or cadavers,23 and a study24 comparing a hemostasis model with splenectomy in anesthetized dogs.
All but 1 of the 17 studies consisted of comparison of an alternative method that involved a nonharmful use of animals with live-animal demonstration, live-animal surgery, or animal dissection. In the remaining study,20 surgical training with cadavers was compared with surgical training on anesthetized animals. This study was included because at the time, use of cadavers for surgical training in veterinary medicine represented the state-of-the-art alternative to live-animal surgery. In addition, it is possible to obtain cadavers from animals euthanized for medical reasons and several schools and colleges of veterinary medicine have implemented client donation programs.

Evaluation methods

­
With the exception of the 2-period crossover study,14 which compared faculty and student impressions of a software program demonstrating cardiovascular principles versus live animal demonstration, all of the studies20,22-24 incorporated some type of standardized, quantifiable outcome, such as an assessment of surgical performance. In 1 study,20 burst pressure of anastomoses was examined. Other quantifiable outcomes included performance on laboratory reportsb and grades on examinations.21,25-33,c.

Outcomes

In all 17 studies, results associated with the alternative method of instruction were either not significantly different from or superior to results associated with the conventional method of instruction. 

Discussion 

In the present study, although we were able to identify a relatively limited number (17) of controlled studies that evaluated leaning outcomes of traditional versus alternative methods, in all studies that were identified, the alternative method yielded results that were not significantly different from or were superior to results obtained with the conventional method of instruction. These findings appeared to be robust, as
they involved a wide range of participants, alternatives, and outcomes. All studies used a comparison group, and most were randomized. All but 1 included quantifiable outcomes, such as examination grades, and in the veterinary studies that involved subjective assessments of surgical skills, the evaluators were blinded to teaching method. Thus, our findings seem to support more widespread adoption of alternatives to the terminal use of animals in biomedical education.
Our review of the literature revealed that alternative methods have been developed for a wide range of teaching outcomes. In the field of veterinary education in particular, models of parenchymal abdominal organs that have been developed have been found to be as realistic in regard to tissue handling properties as actual organs.34 This seems to suggest that barriers to more widespread adoption of alternatives are not technological.
Many of the studies that we reviewed are > 10 years old. Thus, some of the alternative methods that
were used are themselves now outdated. This is particularly true for films, videotapes, and early computer- based alternatives, which have become outmoded because of subsequent advances in computer technology. In contrast, animal-based dissection, demonstration, and surgical teaching exercises have likely changed little in terms of the technical aspects of the learning. Thus, many of the comparisons in the present study in which no differences were found between alternative and conventional teaching methods likely represent worst-case scenarios. It could be argued that with the use of currently available virtual-reality technology, alternatives might score considerably higher in formal comparisons.
Some of the advantages cited for alternative teaching methods include reductions in faculty teaching time, costs associated with purchasing animals and maintaining animal colonies, and the number of animals killed; an increased ability for students to repeat procedures until skills are mastered; greater flexibility in terms of when students can complete exercises; greater ability for students to work at their own pace; and, for many students, equal or superior academic mastery of the subject matter and the required manual dexterity skills. In addition, alternative methods provide students and faculty members who have ethical objections to the terminal or harmful use of animals a viable method for achieving their educational objectives.
Virtual reality technology has the potential to revolutionize alternative teaching methods,35 and virtual reality methods are being applied in veterinary medicine.16,19 However, even relatively unsophisticated methods can be used to provide students with training in basic surgical skills.36-40.

Importantly, studies included in the present review had some limitations. Some studies20,28 included small sample sizes, and some measured outcomes of individual students when groups or teams were used for randomization purposes,20,21,31,33 included only vague descriptions of methodology and testing methods,25 provided insufficient information about the extent of use of conventional methods in the alternative teaching group,27 or provided limited head-to-head comparisons of alternative with conventional groups.14 The 2 studiesb,c published only in abstract form were difficult to assess because of the limited amount of information provided.
Despite these limitations, none of the studies included in the present review reported that the alternative method that was studied was inferior to the conventional method. This finding, coupled with the successful implementation of alternative teaching methods in a wide variety of veterinary school programs, argues that alternatives are a viable method of instruction in the field of biomedical education. Thus, we would encourage biomedical educators to consider how adopting alternative teaching methods could be of benefit to their teaching programs, students, and faculty members.

a. Balcombe J, De Boo J, Knight A. Comparative studies of student performance: humane teaching alternatives demonstrate superior efficacy to harmful animal use. Available at: www.eurca.org/downloads/animaled/comp.doc. Accessed Dec 11, 2006.
b. Dewhurst DG, Meehan AS. Evaluation of the use of computersimulations of experiments in teaching undergraduate students (abstr). Br J Pharmacol 1993;108(suppl):238. 
c. Henman MC, Leach GDH. An alternative method for pharmacology laboratory class instruction using biovideograph tape recordings (abstr). Br J Pharmacol 1983;80(suppl):591.


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(See attached pdf for Appendix with summary of 17 comparative studies.)


From the Center for Animals and Public Policy, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA 01536. Address correspondence to Dr. Patronek.

Pam Runquist
Director of Companion Animal Issues
Association of Veterinarians for Animal Rights
PO Box 208
Davis, CA 95617-0208
Tel: (530) 759-8106
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