|A peek inside FRED, also known as the Flexible and Rigid Endoscopic Training Device, reveals life-like endoscopic shots of the stomach region (shown above). Veterinary inventor Dr. Jacqueline Whittemore hopes that models like this might one day lessen the need for veterinarians to train on live animals.
A toy dog stuffed with a menagerie of everyday materials might soon lessen the learning curve for veterinarians studying small-animal endoscopy, and in the process, save the lives of animals used for training purposes.
Meet FRED, or the Flexible and Rigid Endoscopic Training Device. The fluffy, floppy-eared dog with a wagging tongue was purchased from a thrift store, yet its internal organs are the creation of Dr. Jacqueline Whittemore, assistant professor of medicine at the University of Tennessee’s (UT) veterinary medical program, and former student Dr. Katy Kottkamp, who now practices in Georgia.
Scope FRED’s stomach, and Whittemore promises a realistic experience, apart from tissue colors that are less than 100-percent accurate. Yet if the toy dog stuffed with craft and industrial supplies becomes fully licensed and mass-produced, it has the potential to alter endoscopy training for veterinary medicine, she says.
“It’s so exciting,” gushes Whittemore, who’s held the idea of creating simulator training for endoscopy since performing her residency at Colorado State University. Conceptually, endoscopy is easy to learn, she says. But in truth, maneuvering the instruments takes a lot of finesse.
Whittemore likens the fine motor skills needed to perform endoscopy to that of learning to drive a race car or playing some video games. Human doctors, for example, train with extremely expensive virtual reality programs or by practicing on live animals, usually pigs.
“It’s the challenge of less is more,” Whittemore says of the technique. “It’s hard to get your hands used to how these machines are designed.”
That’s why FRED as a simulator makes great sense, she contends. Without the stress associated with practicing on live animals, veterinarians can concentrate on maneuvering the endoscope. When they move on to practice with live animals, the training might translate to less stress for the patient.
“Nothing replaces the real-life experience,” she says. “But it’s been shown that human doctors who have simulation training before working with human patients have shorter anesthesia times and fewer complications. To me that’s really important.”
It might also be vital to the research dogs that veterinarians use for training, which traditionally involves terminal labs. Although endoscopy procedures are considered minimally invasive under normal circumstances, Whittemore says that to make labs affordable, several veterinarians must practice on a single patient. That lengthens anesthesia times and increases the potential for complications, so the dogs are euthanized in the end.
Whittemore hopes that with practice on FRED, students of endoscopy might not need to spend as much time training with live animals.
“I became a vet to save lives, and I certainly don’t want people learning this by trial on their patients,” Whittemore says. “Potentially, we can elevate the training to survival surgeries. You can’t kill FRED.”
The notion of FRED has Dr. Brendan McKiernan, a Veterinary Information Network consultant and internal medicine specialist with Southern Oregon Veterinary Specialty Center, impressed. An inventor in his own right, McKiernan dried cadaver lungs to train his colleagues on bronchoscopy in the 1980s. He uses those same models to teach veterinarians the basics today.
“If (FRED) provides a good representation of the anatomy and a feel for scoping, it would be fantastic,” McKiernan says, noting that in the past, air-dried stomach models have been too rigid for teaching purposes. “Scoping is like learning how to drive. The purpose that the model would really serve is to teach the mechanics of the scope. Once that’s learned, it’s easy to transition to live animals.”
Whether FRED makes it to endoscopy training labs remains in question. While the UT Research Foundation holds a provisional patent on the model, FRED is still a prototype. Mass production is another hurdle and might take the resources of an outside company to get underway.
In the meantime, Whittemore isn’t finished with FRED’s improvements. She’s working on a urinary model and envisions a day when FRED models expand to include other species. Other future FRED uses are anticipated to include cystoscopy, bronchoscopy, feeding tube placement, laparoscopy and transtracheal wash.
"I've got lots of ideas,” Whittemore says. “I’m really looking forward to getting him into people’s hands.”
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