Is it still necessary to use kittens to teach pediatric medical residents how to insert breathing tubes into tiny babies?
Doctors at Albert Einstein Medical Center say yes. The Physicians Committee for Responsible Medicine thinks not.
The Washington-based nonprofit group, which says it has 10,000 physician members, said this week that it plans to file a complaint about the practice against Einstein on Thursday. The complaint is to be filed with the U.S. Department of Agriculture's animal care office in Raleigh, N.C. The group contends that practicing on kittens violates the Animal Welfare Act because training programs can use simulators that are just as effective. Kittens could be hurt or killed during the training.
John Pippin, a cardiologist and director of academic affairs for Physicians Committee for Responsible Medicine (PCRM), said that, based on surveys by the group, no other training programs in Pennsylvania or New Jersey use animals to teach intubation. Einstein is among only nine of 201 accredited pediatric residency programs in the United States that still use ferrets, kittens, or cats to teach endotracheal intubation.
"We are perplexed that Albert Einstein … is continuing to do this when all the fine institutions around them with strong reputations are not doing it," Pippin said. He added that his group had been trying to persuade Einstein to quit using kittens since September 2010.
Damien Woods, director of public relations for Einstein Healthcare Network, said Einstein also uses plastic models and simulators to teach airway management skills. But, he added, "Einstein cares for many critically ill newborns and believes the teaching of safe airway management skills is enhanced by the use of additional training methods to care for premature neonates — some weighing as little as a single pound." Woods said the trachea and "tissue movement" in the kittens was more like those of a premature newborn.
The residency program uses two kittens a year, and none has died as a result of the training, he said. Once the training is completed, they are adopted. "No animals are harmed and the animals' care is supervised by a committee composed of veterinarians, physicians, and laypeople," he said.
Pippin said 12 training programs stopped using live animals in the last 2½ years after being contacted by the physician group. It has filed USDA complaints about three others. One is pending and the two others did not result in findings of Animal Welfare Act violations, Pippin said.
The pending complaint is against East Carolina University, which continues to use its 18 ferrets to train residents, medical school spokesman Doug Boyd said. He said a faculty member used scholarly articles to justify using the ferrets. The school also uses computer models and simulators.
In January, Steven DeKosky, dean of the University of Virginia School of Medicine, which was the subject of a similar complaint in 2011, said doctors at his school "do not believe a simulator is currently available to teach this delicate procedure effectively enough to give physicians the level of proficiency they need to perform an intubation in the 30 to 60 seconds it takes to save a premature baby's life. ...
"All physicians must first become proficient on simulators before they are allowed to perform the procedure on a cat."
Samuel L. Jacobs, an obstetrician who works in Philadelphia and signed the complaint against Einstein, said he learned to insert breathing tubes on kittens 30 years ago, when there were no alternatives. Now, he said, simulators are better than cats because the bodies of cats and babies are quite different. "My goal is to train the best doctors that we can," he said, "and using kittens is not the best way to do it."