Past ACVS Surgery Summit Working Groups

Facilitated by Jason Bleedorn, DVM, MS, DACVS (Small Animal)

The working group discussed the current state and the future of arthroscopy training. Most attendees were involved in resident training, performing more than five arthroscopic procedures per week, with all joints scoped. The group discussed various training structures, including orthopedic boot camps, cadaver labs (some utilizing older equipment, others nano arthroscopes), and model development. They highlighted one key concern: how to effectively train residents on clinical cases, including portal placement, time management, and appropriate levels of supervision. Challenges include access to updated equipment, cadavers, and funding. Private practice perspectives highlighted the difficulties of training without cadavers and within time constraints, emphasizing the need for realistic expectations for graduating residents and a focus on competency.

Participants acknowledged arthroscopy as the current standard of care and discussed strategies for its advancement, including client education and promotion. Several ongoing and future research projects were highlighted, such as modified ASSET validation with residents and attending surgeons and the developing of a framework for arthroscopy model validation. The group proposed a consensus paper on the topic to increase visibility, with plans to connect with Veterinary Surgery to explore this possibility. Recurring Zoom discussions and future meetings of the working group were suggested to maintain momentum and to continue further discussion and advancement of arthroscopy training.

Facilitated by Eric Parente, DVM, DACVS

The working group discussed diagnosing intermittent dorsal displacement of the soft palate (IDDSP), asking if an exercising examination is always required to make the diagnosis and if surgeons subjectively observe different significant ways horses displace during the exercising examination. The group determined that surgeons should continue to advocate for exercising examinations to ensure surgeries are performed for the correct diagnosis and to rule out other upper airway abnormalities. Participants identified that there are increasing social concerns about horse management and that it is increasingly important to have justifications for surgery with exercising examinations. However, the group also mentioned that tie-forward, or sternothyroid tenectomies, are often performed without the exercising examination because of its low risk of complications and trust between client and surgeon based on the client’s experience and interpretation. The group then emphasized the importance of considering other upper airway abnormalities, such as epiglottic and intermittent epiglottic entrapment and its role with IDDSP. Participants discussed the role of lower airway issues and how they appear in both show and western performance horses. Next, they explored treatment options for IDDSP, highlighting the need to identify the underlying cause. Tie-forward was deemed the preferred method for most racehorses, while tenectomy was considered a first-line option for younger horses needing a quick recovery. Discussants questioned the efficacy of palate last treatment and thermocautery, with the impacts of these techniques identified as more helpful for the clients rather than the patients.

The discussion covered other pharyngeal abnormalities, like dorsal pharyngeal collapse and the importance of first evaluating and addressing lower airway issues. Treatment options were identified, such as salpingopharyngeal fistual and alar fold resections to change resistance. The working group concluded with next steps to better help treat patients, such as the need for more research to build stronger evidence for treatment efficacy and recognizing breed and occupation-related differences in treatment approaches.

Facilitated by Megan McCracken, DVM, DACVS (Large Animal)

The working group represented a mixture of private practice and university perspectives from surgeons who performed emergency duty in addition to elective daytime surgery and lameness cases as well as emergency-focused surgeons and clinicians.

The group first identified what sustainable equine and large animal emergency care should look like. They concluded that strenuous, all-day work hours and nightly on-call schedules are unsustainable. The group indicated that tolerance of emergency care, long hours, and overnight work is variable and depends on a surgeon’s age, career experience, and family life. They also emphasized the importance of a predictable and consistent schedule, effective case transfer and team member trust, and availability of clinicians, technicians, and assistants who can handle more emergency cases while the surgeons are on call for surgery only.

The second topic of discussion focused on the financial viability of equine and large animal emergency care practices. The group discussed appropriate emergency costs and fees for after-hours care (such as tiered emergency fee schedules that increased in cost later at night compared to early evening) and lower-cost euthanasia options for owners. They also suggested additional hospitalization charges, additional emergency fees for specialists, and subscription fees for practitioners to pay that would cover referrals to an emergency practice.

The final topic of discussion centered on promoting careers in equine and large animal emergency care. The group discussed that current AAEP recommendations promote sending emergency cases to referral hospitals, leading to an increased caseload of primary care emergencies, and suggested involving general practitioners in initial care and triage at referral centers. The group noted that there are multiple opportunities for general practice veterinarians to develop emergency treatment skills, as seen in small animal surgery education, to have the ability to treat the spectrum of emergency cases at the highest level. They acknowledged that encouraging new veterinarians to pursue a career in equine and large animal emergency care would require more structured or defined work hours, flexibility of schedule, the ability to treat interesting cases, and ample financial compensation. They emphasized appropriate mentoring for new graduates in emergency-only practice, as well as support and appreciation from others in the practice, hopefully translating to increased career satisfaction and retention.

Facilitated by Teri Kleist, CVT, VTS (Surgery)

The working group featured a panel of subject matter experts: two Doctors of Veterinary Medicine (DVM), Alan Cross and Jodie Lamb, and three credentialed technicians with a VTS in surgery, Sandra Engelmeyer, Steven Frederick, and Danielle Browning. The discussion began with an introduction from panel members, who each went into detail about their current working environment.

The first topic was directed toward the DVMs, asking them why they use their technicians the way they do. The doctors expressed that technicians allow them to deliver a better standard of care and that well-utilized technicians allow practices to generate more revenue and allow for a shorter workday. The doctors praised technicians, referring to them as “Swiss army knives” as they are versatile and effective. The doctors also recommended a combination of technician staff with general practice and surgical practice experience, as general practice technicians have vast prior knowledge and tend to be under-utilized.

Technicians were asked about technician utilization in the current structure of their clinic facility. One technician’s facility has one specific scrub technician and a pool of technicians to handle everything else (anesthesia, rads, diagnostics), all of whom are licensed in Colorado. Another technician’s facility includes two full-time pack and prep technicians and two certified equipment technicians. The final technician panel member shared that their facility is a large animal academic facility and provides a team approach, where shared knowledge and team recognition are encouraged.

Finally, the panel discussed suggestions for increased utilization, the roles of DVMs, and where the technician profession can evolve from here. The panel emphasized training technicians should perform tasks/practice using DVM-preferred methods/techniques and be empowered to ask questions. A significant emphasis was placed on communication between doctors and technicians in order to match a doctor’s preferred involvement and needs. To advance the profession, the panel suggested that doctors acknowledge and appreciate their technicians, as they can “make or break” a practice. Appropriate pay, retention, trust in the team, and appreciation were all major talking points discussed by the panel. The working group concluded with the understanding that veterinarians could likely utilize technicians more effectively.