APRIL KUNG, DVM ♦ December 28, 2017
Dear Future Veterinarian,
If I could go back and do only one thing differently in vet school, I would change the way I studied anatomy. Here’s probably the single most important piece of advice you’ll get about getting the most out of vet school:
Study Anatomy Like a Surgeon, Not an Anatomist.
Virtually all small animal veterinarians perform surgery, whether these surgeries are elective such as ovariohysterectomies, or emergency surgeries like splenectomies or corrections of gastric dilatation volvulus (aka bloat). When you’re the doctor, and no one is there to help or guide you, there is nothing more terrifying in the world than performing surgery. After you slice through skin, fat and the fibrous linea alba, there before you, sliding to and fro with every anesthetized breath, will be your patient’s glistening and vulnerable abdominal organs. Now you must plunge your gloved hands inside to squeeze and pull and palpate. I promise you, unless you prepare as I suggest, the moment you, as the doctor, stand gowned, gloved and masked over your patient’s open abdominal cavity, will be the moment you realize your knowledge of surgical anatomy is quite inadequate to the task.
You’ll begin studying anatomy in your first semester of veterinary school. The way you’ll be taught anatomy is great – if you want to be an anatomist – but it will not make you a competent surgeon. This isn’t to say anatomy classes and labs won’t be helpful at all. There’s much to be gained from dissecting an animal cadaver down to the bones in order to memorize the minutiae of every bone, muscle, organ, artery, vein, nerve, and lymph node. But the knowledge gained from this exercise is not directly pertinent to surgery, and you won’t have another opportunity later in vet school to use an animal cadaver to learn surgical anatomy.
“After you slice through skin, fat and the fibrous linea alba, there before you, sliding to and fro with every anesthetized breath, will be your patient’s glistening and vulnerable abdominal organs.”
Take advantage of your access to a real animal cadaver to teach yourself surgical anatomy as a first year student. Find out what surgical textbook your school uses and purchase or borrow one. Read the step-by-step directions for the surgeries in the following list that most small animal veterinarians need to be able to perform. Use any spare time you have in your anatomy labs to practice identifying and manipulating the tissues described until you have an understanding of the surgical procedure and a tactile familiarity with the relevant anatomical structures.
This will also help you identify gaps in your understanding of the text book descriptions. Surgical text books are written by people who know what they’re doing for people who don’t know what they’re doing. When you know what you’re doing, it’s really hard to remember what it was like before you knew what you were doing! I find surgical text books sometimes skip steps that seem obvious to the experienced surgeon. If you can discover in advance what confuses you about these surgeries, you’ll know which questions to ask in your surgical lectures and labs later.
- Cryptorchid surgery
- Umbilical hernia repair
- Gastric dilatation volvulus (GDV) correction
- Small intestinal resection and anastomosis
- Lateral Suture Stabilization (for cruciate rupture in the knee)
- Limb amputations
- Laceration repair
Many of the animal cadavers we had in our anatomy labs had already been neutered or spayed. If you face the same situation, learning to identify and handle structures related to reproductive surgeries may not be possible in lab. However, you can still cross reference surgical and anatomy textbooks with your cadaver to identify where these reproductive structures were before they were excised.
During your scheduled anatomy laboratories, your professors will have their own agendas, and you may lack the time to focus on anatomy as it relates to the above surgical procedures. However, you should be able to access your anatomy cadaver outside of scheduled labs. At my vet school, first year students could use cadavers for self-directed study whenever desired as long as one of the lab rooms were free. When you begin your anatomy labs in veterinary school, ask the laboratory technicians when and how to access your cadaver outside of the scheduled labs.
If you’re bold, I also suggest you ask permission to use your anatomy cadaver outside of lab time to practice skin sutures. I had to practice skin sutures on sponges as a third year veterinary student. Believe me, practicing on actual skin is a far superior learning experience. If your professor will allow this, he or she will likely give you some direction as to where on your cadaver you can practice suturing without interfering with the anatomical structures you will be studying.
“…when you find yourself unable to get the skin edges to line up…”
Your dissection kit should contain the instruments you will need for suture practice: Scalpel, forceps, scissors, and hemostats. (Hemostats can be used during practice in lieu of proper needle holders.) You’ll also need suture material. Most veterinary hospitals keep expired suture material on hand for students to practice with. Ask one of the hospital surgeons or a surgical resident if they can get you a few packs. Your surgical textbook will have descriptions and diagrams of various suture patterns, as well as instructions on proper surgical instrument handling. Read carefully, and while you practice, make sure to adhere closely to your text’s recommendations on handling the instruments to avoid developing bad habits that will be hard to break later. The most important suture patterns to practice are the simple interrupted, the simple continuous, the cruciate, and the Lembert patterns. Practice tying good square knots, and burying knots under the dermis. Again, the surgical textbook will have directions to help you.
Also ask your anatomy professor if you can cut out a few small patches of skin so you can practice closing irregular defects. Unlike merely suturing closed a straight skin incision, as you would after completing an abdominal surgery, learning to close an irregular skin defect will mimic the challenges you’ll face later as a veterinarian when you perform skin mass excisions, biopsies and laceration repairs. Those surgeries are not typically terrifying, but they can be frustrating and nerve racking when you find yourself unable to get the skin edges to line up without creating unsightly bulges. Your surgical text book will have directions and diagrams for closing irregular skin defects, likely in the section about skin biopsies and skin tumor removal.
If your anatomy professor won’t allow you to practice suturing on your cadaver, it’s most likely because they worry you’ll develop incorrect technique from practicing without direct supervision, and they don’t want to make the surgery professor’s job harder in the future. Don’t take it personally. We don’t always get what we want when we ask, but if we don’t ask, we never get what we want!
The above is an excerpt from On Being a Veterinarian: Book 2: Getting the Most Out of Vet School. If you’d like me to email you when the book is released, please subscribe to my email list.