Veterinary Simulation: virtual platforms in animal medicine

Veterinary simulation is also changing animal medicine training by providing safe and realistic learning environments. Thanks to technologies such as virtual reality and interactive platforms, students can develop clinical skills, improve decision-making and reduce errors, all without putting the welfare of real patients at risk.

Introduction to clinical simulation

Clinical simulation is a teaching methodology that aims to create the conditions of authentic clinical situations, hoping that students will generate reflective thinking and improve their skills. This type of simulation can not only be carried out in a tangible scenario, but also through virtual methodologies. (INACSL, 2016)

This teaching methodology is based on experiential learning, in a controlled environment, where there is physical, psychological and emotional safety suitable for the student to achieve their learning outcomes and develop the skills and competencies necessary to exercise their professional role. (Afanador, 2012)

The clinical simulation methodology consists of a pre-debriefing stage characterized by the construction of the scenario based on the learning outcomes, the physical preparation of the environment where the scenario will take place and the administrative aspects that all this entails (request for supplies, coordination with actors, etc.). The next stage is the briefing where the tutor gives the guidelines, learning outcomes, instructions regarding the use of phantoms or simulators to the students. It is important to emphasize that at this point the physical, psychological and emotional safety surrounding a simulated environment is mentioned. After this, the proposed scenario is executed. This scenario can be of high fidelity with situations very similar to the reality that the student will face, or of low fidelity whose environments are not very similar to reality. The role of the tutor changes according to the type of fidelity in which the student finds him or herself, being more intrusive in low-fidelity scenarios and remaining on the sidelines in high-fidelity scenarios. Once the scenario is over, the debriefing takes place, an instance where the students, with the help of their tutor, reflect on the decisions, behaviors, and application of theory that the student had within the scenarios, all in an environment of respect, psychological and emotional security.

Clinical simulation is not just the experience of a scenario, it is the deep reflection on the scenario experienced guided by a tutor who leaves aside his instructive function to take on the role of a companion in the neurological learning processes of the student.

In this context, clinical simulation models take on special relevance, as they offer a fundamental learning and practical possibility in training in the area of health, even more so in the case of veterinary sciences. It allows the student to become involved in the scenario, identify the problems, carry out an exhaustive collection of signs, symptoms and clinical data, interpret complementary examinations and assume the appropriate clinical management of the patient.

Clinical simulation corresponds to the set of illustrative situations and practices that have the purpose of duplicating or representing events, behaviors or activities that occur in the work environment, which allows for the training and/or evaluation of specific abilities, skills, aptitudes and knowledge in a reliable and safe way. The objective is to allow students and participants to use these abilities, skills, aptitudes and knowledge in situations that are as real as possible, translating them into real-life situations in similar contexts, helping to minimize error before applying the procedure to a real patient, so that the trainee acquires the necessary “expertise”. (Decloedt et al., 2021)

Importance of Clinical Simulation in Veterinary Training

In Chile, on July 19, 2017, Law 21,020 was enacted, establishing responsible pet ownership and classifying animal abuse as “any action or omission, occasional or repeated, that unjustifiably causes harm, pain or suffering to the animal” (Law 21020 of 2017) which leads to the limitations of animal handling by veterinary medicine students who have little or no experience, putting the welfare of their patients at risk on more than one occasion. In this context, the INACSL Standards of Best Practice: SimulationSM Outcomes and Objectives (2016) establish that all simulation-based experiences should begin with the development of measurable objectives designed to achieve expected results. These standards, applied to clinical health simulation, promote patient safety, the training of technical and non-technical skills, teamwork and effective communication. These practices are perfectly transferable to veterinary medicine, helping to reduce accidents during veterinary consultations, promoting the safety of the patient, the guardian and the veterinarian, and reducing deaths from iatrogenesis and medication errors, among others.

Limitations of Clinical Simulation

The introduction of clinical simulation to veterinary medicine is a step forward in terms of animal welfare and the teaching-learning processes for students. However, for it to be implemented, an adequate infrastructure is needed that is adapted to the needs of the academic programs and learning outcomes, as well as adequate materials and trained personnel. It is clear that recreating a high-fidelity scenario of a small animal consultation requires fewer associated costs than recreating a scenario where one has to work with farm animals. Another aspect to consider is that veterinary simulators lack the technology of their human clinical simulation counterparts, the vast majority of which are manual simulators lacking software to simulate vital signs, sounds or movements. Many of these limitations can be resolved with the use of virtual platforms that assist in the process of creating and executing scenarios.

Veterinary Goes Virtual!

Virtual platforms in clinical simulation

The use of digital platforms for simulation is not a new issue, in fact, it was greatly boosted by the COVID-19 pandemic. These digital environments have proven to be effective in the acquisition of skills in health students, also generating a higher degree of satisfaction among them, without proving to be better or that non-virtual simulation (Liu et al., 2023), their use also encompasses other benefits beyond the acquisition of techniques, such as the performance of cognitive skills such as memory, attention and problem solving, which will benefit the student during their training cycle, allowing them to gradually complete their training (Farag & Hashem, 2021; Liu et al., 2016). It has been shown that technologies applied to education have other benefits such as recreating unusual situations, safety for the student, promoting active learning, the student is able to progress at their own pace and carry out the scenario or scenarios as many times as they consider appropriate. (Lifshitz et al., 2021)

Types of virtual platforms

The virtual platforms used in clinical simulation are also considered on their own in the methodology of gamification, in other words, the use of games in environments unrelated to gaming, such as a classroom (Deterding et al., 2011). However, we must remember that these platforms can be used in the field of veterinary clinical simulation, as they can supplement or improve the student’s experience in the execution of the scenario, but they do not replace or omit the other parts that make up a clinical simulation.

Among the virtual platforms that have been used in veterinary clinical simulation are:

1. Non-immersive first-person simulation games: this type of simulation game in the educational field is called serious games since its main objective is not entertainment as such, but the development of reflective thinking, analysis or memory (Mejías-Climent, 2021). The student takes on a role, but is not immersed in the game environment and cannot interact with all the graphic components on the screen. It is usually played on a computer or a video game console.
2. Virtual Reality: Immersive virtual reality (VR) is a computer-generated simulation in which the user is completely immersed, using devices such as stereo screens that surround the visual field and detect orientation and position or the glove that simulates touch (Ordóñez, 2020). This tool can be dynamic, that is, the user interacts with the scenario.

Use of Virtual Platforms in Veterinary Clinical Simulation

Virtual veterinary simulation platforms are not limited to gaming products applied to simulation. Strategies such as role playing using a virtual meeting platform (Zoom, Teams, Meet, etc.) where students take on the role of tutor or veterinarian and conduct an interview to gather information about the pet, have been shown to increase student motivation, improve knowledge integration and give students a greater role in their own learning (Alvarez et al., 2023). This strategy, which does not require greater expense as it uses free access meeting platforms, enhances non-technical skills such as active listening, effective communication and interviewing the tutor. Within the scope of the simulation, this type of modality must consider a script for the student or actor who plays the tutor, as well as the creation of the corresponding scenario, which can generate an increase in the workload of the teacher or teachers.

Another tool used is the Virtual Veterinary Clinic, a non-immersive simulation platform developed by universities to adapt to their resources. In these case simulators, students interact with virtual patients who respond to their decisions, guided by a virtual tutor who intervenes according to the complexity of the scenario. Students have expressed their satisfaction and sense of success in making diagnoses and treatments without the stress of real patients or tutors (Nolan et al., 2019). However, these platforms have a higher cost due to the investment in programming, design and expert evaluation of cases and scenarios. Algorithms must be programmed for all possible responses, correct or incorrect, that a student can give. Although the platform offers immediate feedback, the instructor’s participation in the subsequent reflective process is crucial. As in any simulation, an adequate predibriefing, brief and dibriefing are required, since virtuality does not completely replace high or low fidelity scenarios (Dhein, 2005).

In the field of non-technical skills training, there are platforms specializing in effective communication with tutors, colleagues and collaborators. A prominent example is the Veterinary DialogueTrainer (VDT), which uses non-immersive simulations through a digital role-playing game with standardized virtual avatars. Students who have used this platform have shown significant improvements in their communication skills when repeating the scenarios, with an average of four attempts per student (Dorrestein et al., 2023). The platform provides automated feedback, identifying areas for improvement and assigning scores based on the Calgary-Cambridge Model. This allows for more autonomous learning, as students can perform the scenarios at any time and receive feedback directly from the platform, without the need for a tutor. However, it is important to remember that the software’s responses are predefined and limited to a range of dialogues and facial expressions, which may not capture human emotional spontaneity. Furthermore, the level of realism of virtual avatars can affect the student’s empathy and emotional control, as they do not activate mirror neurons in the same way as human interactions (Burgos Zambrano & Cabrera Ávila, 2021).

Digital platforms for clinical simulation have also been adapted to virtual reality. This technology has been successfully used in veterinary students to practice technical surgical skills, such as canine ovariectomy, demonstrating that VR is as efficient as conventional simulations in the acquisition of surgical skills (Hunt et al., 2020). Other studies have used VR in orthopedics to evaluate radiographs of canine limbs and pelvis, showing greater student engagement with course content, better information retention and improvements in critical reasoning (McCaw et al., 2022). VR allows for high-fidelity simulations in complex environments such as farms or slaughterhouses. However, its implementation requires a detailed cost-benefit analysis, including the search for suppliers who design VR simulations, the development of algorithms for student decisions, the acquisition of necessary devices such as computers (conditioned computers with RAM, graphics cards) and virtual reality glasses) and a physical space where students can move around without accidents. On video game platforms such as Steam^®, we can find a VR veterinary clinic simulator in the making that is focused on veterinary doctors, created by the company Liekos Studio and costing around $10.93 USD (VetVR veterinary simulator on Steam). VR only replaces the simulation environment, while the other aspects of clinical simulation remain the responsibility of the tutor. Therefore, it is essential that the tutor supervises the student’s actions during the virtual simulation, just as in a traditional simulation, even in environments such as the metaverse, where the presence of the tutor is necessary to provide adequate feedback to the students.

Pedagogical principles

It is not possible to delve into the pedagogical principles of using virtual platforms in clinical simulation without mentioning the pedagogical principles of conventional clinical simulation. It is necessary to mention that clinical simulation is related to the principles of education (constructivism, andragogy, cognitivism and behaviorism), as established by Brunner (2018). These principles support the work of teachers through the construction of learning based on prior knowledge (constructivism), the promotion of meaningful self-learning in adults (andragogy), the particular conditions of students, which implies the design of self-instruction, reinforcement and feedback activities (cognitivism), and the analysis and monitoring of the achievements of the process. Changes in the student’s expectations and background, their previous experience, motivation and affection, lead to learning (Martínez Rizo, 2021).

The aspects of clinical simulation are based on neuroscience, in particular neurodidactics, which is the branch of neuroscience applied to education. This establishes synaptic connections as the physiological axis of learning and postulates that having an environment conducive to the creation of new synaptic routes favors learning, especially if we consider the tutor-student relationship, as well as active learning experiences that have an emotional component (Begoña, 2013).

Connectivism is a current that is also present, more than in the simulation itself, in the process of learning through technologies. This new theory coined by Siemens (2004) relates the technological advances of the digital age to learning, establishing that due to the high exposure and growth of information, the subject must be connected to networks or nodes of information and as these nodes increase, access to information and learning increases. It also establishes that the latter can reside in non-human artifacts and it is the individual himself who decides what he wants to learn. (Gutiérrez Campos, 2012).

Conclusion

The use of simulation platforms is useful when there are limitations such as a lack of patients or risk to them. These platforms are effective for training clinical skills, improving student safety and reinforcing learning, but they do not replace interaction with real patients or tutors.

They require implementation and maintenance costs, as well as teamwork between programmers and instructors. It is important to ensure that the scenarios align with academic objectives and that software, hardware and training costs are considered.

In short, these platforms are useful tools but they are no substitute for real interaction and they require adequate planning to avoid being limited to gamification.

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