Historical Perspective

Historically, and still contemporaneously in many veterinary schools, terminal use of animals to teach surgical, and less often, clinical procedures such as resuscitation, is commonplace. Terminal use means that the animals are killed at the completion of the educational task (or tasks in the case of multiple survival procedures). By the mid-1980s however, there was growing societal appreciation of animals as beings with moral status and interests worthy of protection (Lairmore and Ilkiw 2015). A survey of veterinary schools across the United States and Canada indicated considerable change in the traditional reliance on terminal laboratories to teach veterinary surgery, with increasing use of cadavers and inanimate models (Bauer 1993). Nevertheless, 27% of veterinary schools were still killing animals before recovery from anesthesia, with 69% using terminal exercises in small animals, and 20% using them in large animals.

Within the United States, although invasive procedures and terminal surgeries continued in most schools, the majority were offering alternatives by 2004 (Anon. 2004). In recent years, the replacement of terminal animal use within veterinary surgical training has been gaining pace. Veterinary schools that have eliminated such animal use include the School of Veterinary Medicine at Tufts University (the first veterinary school in the United States to eliminate all terminal procedures in all species), the University of Pennsylvania, Michigan State University, The Ohio State University, the University of California, Davis, and, in 2020, Tuskegee University. In 2021, the College of Veterinary Medicine at Colorado State University has begun developing a roadmap “to move the school away from the use of terminal procedures for teaching and replacing that component with activities of equal or greater educational value by using models, cadavers, virtual reality, and supervised surgical experiences on live animals in real-life settings, such as in spay-neuter clinics” (McReynolds 2021). Established in 1998, the Western University College of Veterinary Medicine is one of the most recent US veterinary schools. It promises students “An opportunity to learn how to heal animals without harming them for educational purposes. This is our guiding reverence for life philosophy” (Western University of Health Sciences 2020). However, most US and international veterinary schools still harm and kill animals for teaching purposes.

Animal Impacts

Large numbers of animals are used for educational purposes. Global laboratory animal use for all purposes was estimated at 192 million in 2015 (Taylor and Alvarez 2019). It has been estimated that in any country, animal use in education and training amounts to 1–10% of the total number of reported animals (Akbarsha et al. 2013). This means an estimated 2–19 million animals are used for educational purposes worldwide, each year. Within the 27 European Union (EU) Member States, approximately half a million animals in total were used for the purposes of education and training from 2015 to 2017 (European Commission 2020) – an average of 165,000 animals annually. It is important to note that only animals protected by the EU Directive 2010/63 (i.e. vertebrates and cephalopods) are included in the national statistical reports. Animals who are bred (potentially for other purposes), killed, and their cadavers then used in educational procedures – as is common within anatomy courses, for example – are not included in these statistical reports. The actual number of animals used in education and training is therefore likely to be higher than these estimates.

Many of the animals used in demonstration experiments or terminal procedures suffer significant harms to their welfare, including initial sourcing and transportation, the involuntary disruption of their social networks, confinement, fear, and pain (Knight 2011). Veterinary laboratories teaching clinical skills may be stressful for animals. For instance, transrectal palpation training increases cortisol hormone levels in cows (Giese et al. 2018) and horses (van Vollenhoven et al. 2017), which is indicative of acutely stressful conditions. Finally, the animals do not directly benefit from participation, and many are killed when the educational task is completed.

With respect to terminal animal use, it has often been asserted that when humanely inflicted, such as under anesthesia after a surgical procedure, death is not harmful to an animal (Webster 1994). As we’ve noted elsewhere (Zemanova et al. 2021) however, “Modern conceptualizations of animal welfare … understand that good welfare requires not just the avoidance of negative states, but the experience of positive states. Death permanently prevents such positive states, and indeed, the achievement of any other interests animals could seek to fulfill during the remainder of their lives” (Yeates 2010; Jensen 2017). Accordingly, death is in fact one of the most profound harms that can be inflicted, barring exceptional cases such as genuine euthanasia of those faced with severe, ongoing suffering, with a poor prognosis for recovery.

Human Impacts

The impacts on animals used for educational purposes are well documented. Potential adverse effects on participating students and staff are less commonly recognized.

Live animal use incurs risks of injuries such as bites, scratches, and kicks from large animals, as well as allergic reactions – a common occupational hazard for animal workers. Additionally, anatomy specimens are normally preserved using chemicals of high toxicity – sufficient to prevent colonization by all bacteria, molds, and other organisms. These can create health hazards through direct exposure or aerosolization (Bhat et al. 2019). This creates potential for legal liability should exposure-related adverse effects result. In the experience of one of us (AK) and colleagues from leading veterinary schools internationally, compliance with personal protective equipment such as gloves, gowns, and masks is sometimes lacking (Knight 2007a).

Other impacts are educational and psychological. The invasive nature of animal use within demonstration experiments and surgical training, and the killing of animals for cadaver sourcing, naturally incur high potential for stress within students drawn to the veterinary profession by a desire to care for animals (Capaldo 2004) (see Chapter 22 for a more thorough discussion of moral stress). A recent report of US veterinary students found that helping animals was the most common choice selected as an important reason for becoming a veterinarian (Kipperman et al. 2020). Moral stress can create multiple, adverse impacts. First, such mental turmoil has considerable potential to interfere with the cognitive processes involved with learning and memory, decreasing educational effectiveness. Surveys of veterinary students participating in invasive animal laboratories have identified that they are often distracted from relevant scientific concepts by the plight of their animals, and the necessity of maintaining life and appropriate anesthetic management, which is made considerably more challenging by their lack of experience and supervision (Knight 2011).

Some students find such experiences so upsetting that they may be considered to have suffered psychological trauma (Capaldo 2004). More subtle, but arguably more profound effects appear common. Cognitive dissonance is a discordance between behavior and beliefs (Engel et al. 2020). In this case, the behavior is harmful educational animal use, and the belief is that animals are sentient and should not be harmed. People normally resolve cognitive dissonance by either altering behavior or beliefs. Some students resolve this conflict by leaving or not participating in the exercise or declining to apply for admission – an alteration of behavior. For example, while in veterinary school in the 1980s, one of the editors (BK) boycotted a laboratory in which beagles were to be injected with an intravenous overdose of digoxin while connected to an electrocardiogram (EKG) monitor until death was confirmed. This drug’s effects of causing cardiac conduction blockade followed by cardiac arrest and death were well documented (Atkins and Ames 2018). Hence, widespread continuation of harmful animal use within veterinary schools systematically discriminates against empathic students opposed to harming animals in the absence of overwhelming necessity, making it less likely such students will become veterinarians.

Unfortunately, most students appear to resolve this mental conflict by changing their beliefs, rather than their behavior. Arluke and Hafferty (1996) showed that learning experiences perceived as morally wrong initially lead to ethical uneasiness, but then often progress to desensitization, through the use of rationalizations to justify the behavior concerned. Many veterinary students may therefore start to believe that animals are less deserving of moral consideration. The decreasing awareness among veterinary students of animal sentience (specifically, hunger, pain, fear, and boredom in dogs, cats, and cows) throughout their veterinary courses (Paul and Podberscek 2000), the decreased likelihood of fourth-year students providing analgesia when compared with second- or third-year students (Hellyer et al. 1999), and the inhibition of normal development of moral reasoning ability during the four years of veterinary school (Self et al. 1991) have all been documented within veterinary student cohorts.

This may also represent “compassion fatigue” – a diminished ability to empathize, or feel compassion for others (Pereira et al. 2017). Numerous studies indicate declining empathy for animals as veterinary students progress through training programs (Colombo et al. 2016). These are all desensitization-related phenomena. They are psychological adaptations to the cognitive dissonance created by curricular requirements to harm and kill sentient creatures when such measures do not appear to be clearly justified.

The pressure on such students is immense. Students know that refusal to participate could threaten careers they have put enormous effort into achieving and leave them with university debts that can reach several hundred thousand dollars, without the professional ability to repay them. Acting in accordance with one’s convictions in such circumstances requires considerable courage, and a willingness to risk incurring very serious consequences. Consequently, it is unsurprising that most alter their beliefs, rather than their behavior.

Ultimately, those few students who do not alter their beliefs may not graduate, and those who remain often appear to alter their beliefs, becoming veterinarians with a diminished appreciation of animal interests, and of their capacity for suffering. These outcomes constitute profound harms to the students in either group. Veterinary patients are also potentially at risk when veterinarians are subsequently less likely to consider animals as sentient, or to warrant appropriate analgesia. Some evidence also suggests the veterinary profession at large is less progressive on animal welfare and advocacy issues than society reasonably expects (Knight 2008; Kipperman et al. 2018).

Humane Alternatives

Many humane alternatives have been developed for laboratories in which animals are harmed or killed, and successfully implemented within veterinary curricula internationally. These include computer simulations and videos of professionally performed dissections (prosections) and experiments, noninvasive self-experimentation, ethically sourced cadavers, preserved anatomical specimens, models, mannequins and surgical simulators, and supervised clinical experiences (Knight 2011).

Computer Simulations and Videos

The first computer simulations had simplistic user interfaces. Modern simulations include video clips of animal experiments, showing resultant effects (Figure 18.1), and virtual equipment and body parts, such as nerves and muscles (Figure 18.2). Dissection simulations may offer virtual dissecting kits, from which students must select appropriate tools (Figure 18.3). Correct choices may be rewarded by still images and videos of professionally performed dissections. These prosections successfully preserve and display structures that may be destroyed during student dissections (Figure 18.4). Histological (microscopic) anatomy of tissues and organs may be displayed alongside the gross (macroscopic) anatomy (Figure 18.5).

Some simulations are freely available via the Internet, such as those at www.humanelearning.info. Others are available for a fee, such as the “Virtual Canine Anatomy” program from the Colorado State University College of Veterinary Medicine and Biomedical Sciences (http://www.cvmbs.colostate.edu/vetneuro). The latter provides key information about many anatomical structures (Figure 18.6). Other simulations such as Pro-dissector’s “Face” (Figure 18.7) allow students to click on certain muscles, which then contract, displaying the effects on the visible tissues. Simulations may also provide functional diagrams of working organs (Figure 18.8). They may illustrate surface anatomy (Figure 18.9) and allow rotation to obtain different views (Figure 18.10). They may even provide information about the natural history of the species in question.

Preserved Specimens

Whether ethically sourced or not, animal specimens may be preserved in several ways. This can allow their reuse for years. Potted specimens are preserved using powerful chemicals designed to prevent tissue dissolution and bacterial putrefaction along with color preservatives (Figure 18.11). Colored casts of blood vessels and airways may be made after perfusion of these vessels with colored dyes (Figures 18.12 and 18.13). The surrounding tissues are dissolved by weak acids over prolonged periods. Plastination involves several chemical steps, as well as evacuation. The water and lipids within tissues are replaced by polymers, yielding a plastic texture, and removing most of the odor. Very large animals have been successfully plastinated (Figure 18.14).

Models, Mannequins, and Surgical Simulators

Many models and mannequins have been designed to illustrate anatomy. Others have been created for clinical skills training for veterinary or medical students, or laboratory technicians. Such skills may include venipuncture (blood sampling using faux blood solutions), endotracheal intubation, thoracocentesis, bandaging, splinting, resuscitation, arterial pulse palpation, and auscultation of heart and breath sounds via a stethoscope (Figures 18.15 and 18.16).

There has been an increasing interest in the use of simulation training within veterinary education. Surgical simulators include soft tissue and orthopedic models and mannequins (Figures 18.17 and 18.18). Systems such as the Pulsating Organ Perfusion Trainer (Figures 18.19 and 18.20) use real organs sourced from slaughterhouses or elsewhere. The major blood vessels are perfused with faux blood solution using a closed circulatory system. This system includes a pulsatile pump that simulates a beating heart. This creates bleeding when vessels are deliberately or inadvertently cut, allowing practice of hemostatic (to control hemorrhage) surgical techniques. Surgery may be practiced via both conventional approaches and endoscopic incisions and equipment.

It has also been recognized that skills developed during video gaming correlate with increased laparoscopic surgical skills, and training curricula have been proposed that would include video games (Levi et al. 2019). Haptic simulators are even more advanced. These provide tactile feedback to students’ instruments and fingers that is anatomically appropriate depending on their locations within simulations, such as a virtual bovine rectum (Figure 18.21). Haptic simulators are also used in endoscopic surgical training.

The designer of the haptic bovine rectal palpation simulator-Professor Sarah Baillie, has also created equine colic and feline abdominal palpation simulators.

Educational Efficacy

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