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Hands-on Simulations for Real-World Excellence

Ronald Njau
Ronald Njau, Educational Technology and Software Coordinator at the Learning Assessment Center

Veterinary and human medicine intersect in numerous places, including pedagogical methods and training techniques.

The Learning and Assessment Center at Michigan State University is a result of the collaborative vision of the Colleges of Human Medicine, Veterinary Medicine, Osteopathic Medicine, and Nursing.

This unique multi-college organization allows for efficient collaborations and helps health professions students develop and demonstrate competence in basic tasks and skills. Simulations approximate reality in ways that require students to react to conditions as they would under genuine circumstances. These simulations can include standardized patients, mannequins, clinical vignettes, or a combination of these methods.

Certified by the Society for Simulation in Healthcare, the LAC provides opportunities for students to experience treating patients and communicating with clients before they first hit the clinic floor.

Simulator models

Giving students lots of hands-on experience is one of the strengths of the MSU DVM program, and the LAC does exactly that.

- Robert Sanders

Dr. Robert Sanders began developing a cardiology selective after learning of the LAC’s high-fidelity capabilities. The course is limited to 12 students, and has a waiting list every semester.

The selective puts students at the bedside of an exam room with cardiology patients. The simulation models have dynamic vitals, including heart rate and blood pressure, with stomachs that rise and fall with respiration. Sanders sets the vitals for the simulation and adjusts them by radio frequency as students deliver treatments to the simulator. The entire process is viewed and recorded from a monitor room."

The differences in students’ diagnostic skills and response time between the beginning and end of the semester are phenomenal,” said Sanders.

“These students begin their clinical rotations having experience that is very close to the genuine thing.”

Standardized clients

Ann Rashmir Raven

These simulations give students the opportunity to develop communication skills through scenarios that let the instructor provide detailed and useful feedback.

Simulations are also provided by human actors, called standardized clients.

Dr. Ann Rashmir-Raven uses the LAC in the Veterinary Integrated Problem Solving course. Students are expected to take thorough histories and explain the results of diagnostic tests to a standardized client. Afterwards, students meet in small groups with facilitators, many of whom are local practitioners or clinicians at the Veterinary Medical Center. The small groups view the recordings and provide constructive feedback aimed to improve future client interactions.

Students are introduced to the room by an LAC technology trainer. Veterinary students use two simulators, one with radio-controlled vitals, and one that receives medical treatments.

Students approach an exam table with vitals that have been set by the instructor.

Students examine the patient and determine appropriate diagnostic tests.

Results of all potential diagnostic tests are available at a bedside computer.

Students determine the next course of action based on diagnostic test results.

Students administer medications to the model with available tools and medicines.

Training the Next Generation of Researchers

Megan Porter
Megan Porter, DVM-MS student and NIH Predoctoral T-32 Fellow

Innovative research at the MSU College of Veterinary leads to new understandings of basic science, new cures, and improved standards of care for animals and humans.

Lab Testing

For more than 20 years, the College has been developing innovative research training programs that connect graduates and undergraduates to our rich biomedical research environments. 

Dr. Vilma Yuzbasiyan- Gurkan, now Associate Dean for Research and Graduate Studies, and Dr. John Baker, now Dean of the College of Veterinary Medicine, were the driving forces in launching the College’s first student research programs.

“What adds to our history and makes our programs unique is the combination of support we receive from industry, government, and alumni to build the next generation of scientists, researchers, and practitioners,” said Yuzbasiyan- Gurkan. 

Hypothesis-Driven Biomedical Research

Grants from the National Institutes of Health and the Merial Veterinary Scholars program, matched by College funds, support several summer research training programs.

“Students examine fundamental questions that let them see the implications for their research on diseases in animals and humans."

- Vilma Yuzbasiyan-Gurkan

The programs provide mentored research experiences in hypothesis-driven biomedical research. Accomplished researchers train students to fine-tune research skills, such as experimental design, data analysis, and writing. 

At the end of the summer, students present their projects at the national Merial/NIH Veterinary Scholars Symposium. Here, they meet scientists from around the country and explore a range of careers and specializations.

Other mentored summer research programs are funded by the  National Heart, Lung, and Blood Institute, the National Institute of Allergy and Infectious Diseases, the National Institute of Environmental Health Sciences, and the NIH Office of the Director of Research Infrastructure Programs. 

The programs are built around some of the College’s areas of research excellence and provide students opportunities to work off-site in labs and with services through the USDA and MSU.

Enriching Veterinary Professions through Diversity

Lab Assistant

The College hosts a number of programs structured to enrich veterinary professions through diversity. One such program is the biomedical research training program for students underrepresented in the biomedical sciences. 

Funded by the National Heart and Lung Institute, the program is offered to individuals with a specific intention to pursue an advanced degree after training. 

The goal is to enhance career opportunities in biomedical sciences for individuals from populations that bear a disproportionate burden of poor cardiovascular health. 

The program funds research in two primary areas: cardiovascular research (especially hypertension) and airway disease.

“Students involved in all of our training programs have a unique opportunity to see themselves as part of the bigger research enterprise,” Yuzbasiyan-Gurkan said. “These students become good candidates to participate in further training at MSU, and to embark on careers in research.”

Crystalizing Student Research Interests

Nih Funding

Each year, more than 30 students from the MSU DVM program participate in research training programs that derive their strength from research-intensive faculty.

Areas of research include:

  • Airway disease
  • Cardiovascular
  • Hypertension
  • Infectious diseases and epidemiology
  • Molecular genetics
  • Neuroscience
  • Toxicology

“We’re a leader in building programs that provide cutting-edge research training to and meet the global needs for both animal and human health,” Yuzbasiyan-Gurkan said. “Many students who complete the training come back and tell me they have a stronger sense of what they want to do, and how they want to contribute to society.”

Funding a Health Future

In addition to extramural funding, alumni and friends of the College support year-round veterinary  scholarships.

  • The Witter Fellowship
  • Eskelund Fellowship
  • A. Reddy Fellowship
  • Feline Health and Well-being


Drs. Vilma Yuzbasiyan-Gurkan, William Atchison, Susan Ewart, and Lorraine Sordillo are key contributors to the training grants.

Taking Strides with Joint Replacement

Dejardin Surgery

In the veterinary world, MSU’s College of Veterinary Medicine has led the way in the research and application of joint replacement surgery for companion animals. Dogs and cats, just like people, enjoy the pain relief and renewed range of motion provided by continued improvement in joint replacements.

The more recent orthopedic advances combine design of new implants, refinement of surgical techniques, and advanced engineering.

Winston Xray
“The era of one-design-fits-all is over,” says Dr. Loïc Déjardin. “Today we have at our disposal a vast array of prostheses meant to address specific needs. From cats to Great Danes, we offer cemented, cementless, hybrid, customized, and new designs for most main joints affected by intractable osteoarthritis.”

As the head of small animal orthopedic surgery, Déjardin has positioned MSU as the first academic institution in the world to offer cementless elbow prostheses. “Joint replacements are highly technical procedures,” Déjardin explained. “It’s a combination of state-of-the-art implant design, comprehensive preoperative planning, and meticulous surgical techniques. We work collaboratively with fellow orthopedic surgeons, engineers, industrial partners—including BioMedtrix—as well as research foundations to improve our understanding of joint mechanics, refine implant design, and thus optimize our clinical success.”

Déjardin routinely uses CT-based, 3D-printed bone models for preoperative planning, rehearsal of complex procedures, resident training, and/or design of new implants.

Today, MSU is the only academic institution in the United States that offers a comprehensive total joint replacement program for all major joints—hips, elbows, and knees—with ankle replacement also available. Déjardin is among a long line of clinical scientists who have made dramatic strides to build a legacy of innovation in this complex, ever-evolving field.

Winston

Total joint replacement program at the College

The Orthopedic Surgery Service at the MSU Veterinary Medical Center is made up of world-renowned surgeons who employ the best treatments and technologies to serve patients through the Hospital’s Trauma, Revision, and Joint Replacement Centers. Our orthopedic care is rooted in six distinctive areas: advanced diagnostic imaging, surgery, revision, emergency, in-hospital care, and rehabilitation. Surgeries and procedures related to joint replacement include:

  • Total Hip Replacement—both cemented, cementless, and custom: For treatment of osteoarthritis (OA) due to hip dysplasia or other causes.
  • Total Knee Replacement: For treatment of severe osteoarthritis of the knee.
  • Total Elbow Replacement: For treatment of elbow osteoarthritis non-responsive to more conventional therapies.
  • Total Ankle Replacement: Offered as an alternative to joint fusion in cases of
    severe OA.
Joint Replacement

Prioritizing Patient Care and Veterinary Education

Dr Beal

When the original ICU at the MSU Veterinary Medical Center (VMC) opened in 1965, it was the pinnacle in emergency and critical care veterinary medicine. As medicine evolved, and the life-saving capacity of emergency and critical care veterinarians and technologies advanced the need for an updated facility was clear.

Now, after a donor-funded overhaul, the ICU is back on top. Complete with a high-functioning layout and state-of-the-art equipment, the ICU now also offers a quiet room for feline patients and an in-unit isolation area for close monitoring of patients.

Quality of care

The caseload is skyrocketing, 10-15% a year growth right now.

- Matthew W. Beal

 “The facility now matches the level of care that we’ve been providing,” says Dr. Matthew W. Beal. The design lets in natural light and eliminates visual obstructions, and has a new quiet room and in-unit isolation facility. Beal says the entire team has been able to feel the impact of the renovations, particularly in how busy they’ve become. “The caseload is skyrocketing, 10-15% a year growth right now.”

Eccm Dog

Communicate to educate

“Moving into this space helps keep the doctors and students and the rest of the veterinary healthcare team all in one area, so there’s much better communication between everybody, and it’s going to facilitate teaching, it’s going to facilitate patient care.”

- Matthew W. Beal

According to Beal, the greatest impact the ICU has had on education can be seen in the improved communication throughout the facility.

“It helps keep the doctors and students and the rest of the veterinary healthcare team all in one area, so there’s much better communication between everybody, and it’s going to facilitate teaching, it’s going to facilitate patient care,” says Beal.  “Moving into this space and the continued growth of the service have allowed us to grow our team and for the techs to not be spread between two units . . . The whole space is just a happier place to work.”

Eccm Exam

On the horizon

When it comes to what’s next, Beal foresees the need to continue the ECCM framework. “As crazy as it sounds, we are beginning to outgrow this facility. We are making great use and I think in the near future that expanding it and building more of a traditional step-down ward in the image of the current space may be the next step in progression.”

Beal says the ECCM service also has goals to continue expanding its team and increase their research output, all in an effort to extend the VMC’s mission of clinical excellence, ground breaking research, and teaching.

A Year of Protecting Poultry and People

Chickens

In response to the largest animal disease outbreak in U.S. history, the Diagnostic Center for Population and Animal Health (DCPAH) has been taking steps to ensure laboratory preparedness. The outbreak of highly pathogenic avian influenza virus (HPAI) began along the Pacific coast in wild and domestic birds in December 2014. It exploded in the Midwest in early 2015 with nearly 50 million birds in 15 states affected. In states hardest hit by the outbreak, veterinary diagnostic laboratories have been inundated with samples and have worked diligently to meet the testing needs required.

National surveillance

As a member of the National Animal Health Laboratory Network (NAHLN) and, after participating in national surveillance for HPAI from 2006-2010, DCPAH was one of only five laboratories invited by USDA Wildlife Services to participate in heightened surveillance of wild birds at the outset of the current outbreak. Between early January and mid-March 2015, DCPAH had tested approximately 1,200-1,300 samples from wild birds from as many as 11 states, mostly east of the Mississippi River.

After the outbreak subsided in late June 2015, DCPAH was one of seven NAHLN laboratories invited by NAHLN and Wildlife Services to participate in wild bird surveillance from July 2015–March 2016. This invitation was based on past positive working relationships and the strategic location of DCPAH relative to the wild bird surveillance plan. This will include testing approximately 5,000 samples (out of 40,000 nationwide) over the next several months.

Rapid response

Dcpah Team

On Thursday, June 4, 2015, DCPAH received samples of Canada Geese from the Michigan Department of Natural Resources (DNR). Tests completed that day indicated that the goslings were infected with AI H5. Following protocol, the samples were sent the next day to the National Veterinary Service Laboratory (NVSL) in Ames, Iowa for confirmation. DCPAH received positive confirmation of highly pathogenic avian influenza, subtype H5N2 on Saturday, June 6 and notified state agencies (Michigan Department of Agriculture and Rural Development or MDARD, and MDNR) that same day. On Monday, June 8, Michigan announced the state’s first HPAI detection. Michigan became the 21st state to report a case of HPAI since December 2014 and the 6th state to detect it in wild or free-ranging birds only.

Emergency preparedness

Prior to this finding, DCPAH had been working with MDARD, Michigan Allied Poultry Industries, producers, and other stakeholders to prepare for the possibility of HPAI in Michigan. To assist commercial egg producers in testing immediately in the event of an outbreak, DCPAH secured test collection kits from NVSL and distributed a three-day supply to producers.

The secure supply testing and permitting process is critical to ensuring that no infected products reach the marketplace. The need is greatest for egg producers because of the daily movement of eggs. DCPAH also nearly doubled the number of staff qualified to perform the HPAI assay through additional training and qualifying testing required by NAHLN.

DCPAH continues to meet with stakeholders and ensure laboratory preparedness to help protect Michigan poultry producers.

Emergency preparedness

In addition to efforts around HPAI, several DCPAH staff members were presented with the Federal Drug Administration’s Group Recognition Award for the Lascadoil Animal Feed Contamination Response Group. This award (dated June 25, 2015) recognizes DCPAH’s role in assisting MDARD and the FDA in one of the most complex animal feed investigations in recent memory. The investigation findings impacted numerous feed manufacturers and producers in Michigan, and were linked to approximately 55,000 turkey deaths, disposal of 500 tons of feed and limited the movement of over 35,000 swine to market. The case turned into a nationwide investigation and traceback of a feed product involving the United States Food and Drug Administration (FDA), United States Department of Agriculture and many other state feed and animal health programs.

Avian Influenza

Training for Milk Quality

Erskine With Cows

Consumers are more concerned than ever about the source of food. Many, too, question the use of antibiotics with farm animals and how those medicines may affect what we eat and drink.

MSU’s College of Veterinary Medicine is collaborating with a half dozen partners to reduce antibiotic use by dairy producers through an innovative educational program designed to decrease mastitis in cows. Led by CVM Professor of Large Animal Clinical Science Ron Erskine, the field-oriented project supported by the U.S. Department of Agriculture involves a multi-disciplinary team from the MSU Julian Samora Research Institute, partners from Florida Agricultural and Mechanical University, Pennsylvania State University, and Syracuse University, as well as veterinarians, producers, and other dairy professionals.

“If you can prevent the incidence of mastitis, you don’t have to worry about treating it,” said Erskine.  “That’s what we’re really focused on, as well as helping farmers and their employees become more aware of responsible use of antimicrobials.”
 
Mastitis is an infection of a cow’s udder that typically is caused by bacteria. The persistent, endemic problem on dairy farms leads to economic losses, reduces milk quality, and affects the longevity and wellbeing of the cow. Michigan State’s team of partners, called the Quality Milk Alliance, looks to cut the incidence of mastitis by a third, and to reduce antibiotic use by half, within five years.

Launched in 2013, the $3 million, USDA-funded project involves several stages, the first being to assess current mastitis treatment practices in dairy farms in Michigan, Pennsylvania, and Florida. After conducting focus groups and surveys on farms with herd sizes ranging from 75 to 3,000, the team determined that management and training of employees was key to helping producers improve their overall mastitis protocols.

Erskine Ron

“While the incidence of mastitis has decreased in the last 20 years, you need to take things to the next level to maintain that improvement,” Erskine said. “We have to account for the changing labor structure that occurs as we transition from small, family-owned farms to larger farms with diverse workforces.”

With the initial pilot study complete, the project has entered a second stage that involves yearlong employee education and training on about 130 farms in three states. Depending on the locale, materials are developed with Latino communities and workers in mind. Trainers are sensitized to potential language barriers and cultural issues, and ensure that employees from non-farming backgrounds understand why certain practices and protocols are essential when working with dairy herds.

The third component of the program will be to train individuals from outside the farm to serve as ongoing educators once the project ends. Herd veterinarians are a natural fit for these educational roles, Erskine said, and already have an established relationship with dairy producers and employees. Another outcome of the project involves the development of an online educational tool and “cyber institute” to train and certify specialists to do on-the-farm audits and education.

“Our role is to empower,” Erskine said.
 
“Our program integrates extension, education, and research, and is predominantly in the field. At the end of the day, this has to be a boots-on-the-ground program that can be used by the dairy industry and applied on the farm now. I can see us taking this model and applying it to other things employees do on a farm. It could be bigger than just reducing mastitis and antibiotic use.”

The Quality Milk Alliance is a multidisciplinary team dedicated to reducing antibiotic use among dairy cows by half and mastitis by a third within five years. The alliance represents a partnership among Michigan State University and several institutions across the United States. The project is supported by the Agriculture and Food Research Initiative Competitive Grant No. 2013-68004-20439 from the USDA National Institute of Food and Agriculture.

Team members from MSU include:  

  • Ronald Erskine, professor, Large Animal Clinical Sciences, College of Veterinary Medicine
  • Rubén O. Martinez, professor of sociology and director of the Julian Samora Research Institute Andres Contreras, assistant professor, Large Animal Clinical Sciences, College of Veterinary Medicine
  • Lorraine Sordillo, Meadow Brook Chair, Farm Animal Health and Well Being, College of Veterinary Medicine
  • Phil Durst, MSU Extension senior dairy and beef educator; extension affiliate, College of Veterinary Medicine
  • Stan Moore, MSU Extension educator for dairy, Northwest Lower Michigan and Eastern Upper Peninsula
  • Jean Kayitsinga, visiting assistant professor and social demographer, Julian Samora Research Institute, University Outreach and Engagement
  • Christian Ramirez, doctoral student, Chicano/Latino Studies Program and the Department of Sociology
  • William Escalante, doctoral student, Department of Sociology
  • Bonnie Bucqueroux (deceased), multimedia and social media outreach coordinator; faculty, MSU School of Journalism

College of Veterinary Medicine

Dean Baker

In this report, we highlight aspects of the important work of the College, plus the financial support and business end of making these contributions possible. While the data illustrates the make-up of our College, the stories that accompany that data represent just a few of the accomplishments and programs that we are proud to share with you. 

Preparing our students to be practice- ready upon graduation requires more than medical knowledge and technical ability. Core skills, such as client relations and communication, are vital. The College is fortunate to have the Learning Assessment Center (LAC) as a part of our education model. The LAC represents a collaboration between the Colleges of Veterinary Medicine, Osteopathic Medicine, Nursing, and Human Medicine. This collective project provides hands-on training in everything from client communications to clinical skills in cardiology. The hands-on clinical simulations use high-fidelity models with advanced monitoring equipment and programmed results of diagnostic tests.

The Orthopedic Team at the Veterinary Medical Center offers the best treatments and technologies to serve our patients. Among their many services, Dr. Loïc Déjardin’s joint replacement surgery stands out as a premiere program. As the only veterinary medical care facility to offer comprehensive join replacement—knee, hip, elbow, and ankle—for small animal patients, Dr. Déjardin’s extensive patented equipment, research, and experience is supported and enhanced by the orthopedic legacy that has always been an integral part of the College.

The architectural design of the Veterinary Medical Center’s new Emergency and Critical Care Unit draws from “evidence based design.” The new unit’s open floor plan and natural light draw directly from these principles. The renovated facility was funded almost entirely by gifts from friends of the College.
 
Research is the foundation of these diagnostic and therapeutic approaches, teaching methods, and architecture. The College has trained generations of bench and public health scientists, veterinarians, pathologists, and leaders in a range of other disciplines. Our longstanding research training program has been central to this success. Funding, and some of the finest faculty members in the country, has helped forge our leadership in this training.

Funding also makes possible the education of constituencies that benefit from our research, including research that helps to improve food security. That is the case with a USDA-funded project led by Dr. Ron Erskine. The project brings together the expertise of bench researchers, sociologists, extension educators, and multimedia educators who are all working to bring current science of mastitis to dairy parlors around Michigan and throughout the country.

Research, outreach, and collaboration that protect our food system are some of the contributions of the College’s Diagnostic Center for Population and Animal Health. Our groundbreaking and continuing contributions to emerging and zoonotic diseases are examples of this. In the current avian influenza outbreak, we were one of only five laboratories in the country invited by the USDA Wildlife Services to participate in heightened surveillance of wild birds.

The faculty, staff, and students whose exceptional work are recognized by these accomplishments is a great source of pride for the College and for me personally. I consider it a privilege to lead such a talented group of people in an institution that is committed to supporting the missions of our College: research, education, and outreach that make the world a better place.