When Medical Training Moves Off Campus and Out of Sight
Written by Donya Mand, MD
August 2025
As surgical procedures become more complex and minimally invasive, simulation-based training has become essential to medical education and a core component of surgical and procedural skill development. Traditionally, most medical training occurred at a trainee’s home institution. However, new tools like flexible bronchoscopy, laparoscopy, and surgical robotics have prompted many trainees and medical professionals to attend external workshops to learn these new tools or practice rare techniques.
The growing demand for simulation has coincided with the rise of independent, for-profit simulation centers, also known as third-party training facilities. These centers operate separately from academic institutions and provide workshops to a wide range of medical professionals, including medical students, residents, fellows, physicians, nurses, and surgical staff across the United States and internationally. While they often use the same simulation tools as academic institutions—including cadavers, box trainers, virtual and augmented reality, and synthetic models—many still rely heavily on live animals. As academic centers increasingly outsource training to these facilities, important questions arise about transparency and the continued dependence on animal use, despite the growing availability of effective non-animal models.
Why Outsource Training?
Third-party facilities are filling an important gap in medical training. Consider the following scenarios:
- A trainee wanting to practice a procedure that rarely presents in a clinical setting, attends a focused simulation course, where they can build proficiency and familiarity in a specific skill.
- An attending physician, 15 years out from surgical residency, seeks to incorporate innovative techniques not taught in their original training. Instead of taking time off for a lengthy fellowship, they attend a workshop and introduce these new approaches into their practice.
- A resident physician based in a resource-limited hospital without access to a million-dollar robotic surgical platform to assist in minimally invasive procedures attends a course to gain experience with tools they are likely to use in their future fellowship program.
Although academic hospitals can deliver most of the training needed for a trainee to become a competent physician, some face logistical and financial challenges that limit their ability to offer training in rare skills or the latest approaches. These obstacles include faculty time constraints, equipment costs, and delays in adopting new technologies due to university bureaucracy. Third-party centers allow academic programs to bypass these barriers. While such centers can serve an important need, they only truly fulfill that role if they provide high-quality training while still upholding the highest ethical standards in medical education.
Why Use Live Animals?
A key difference between academic and third-party centers is their degree of financial motivation. Academic hospitals provide training at no additional cost to their trainees, who are more akin to employees undergoing onboarding than customers purchasing an experience. In contrast, participation in courses offered by third-party training centers generally requires payment by the trainee or their home institution. This business model inherently introduces a profit motive, making such centers more susceptible to cost-cutting measures and considerations to maximize market appeal.
At profit-driven centers, animal use may be a way to cut costs at the expense of education. Human cadavers are considered the gold standard for many surgical and procedural skills but are expensive and limited in availability. Although live animals also entail additional costs—such as transportation, staffing, and disposal—they are generally less expensive than cadavers.
Live animal use may also be marketed as a novelty. Most trainees have experience with cadavers, but few have used live animals. This limited exposure to live animals in medical training stems from their reduced use in academic settings, partly due to logistical burdens on the academic facility, such as the need for veterinary personnel, specialized equipment, animal housing, and proper disposal after use. Additionally, ethical considerations and a shift toward newer, innovative technologies likely contribute to this trend. Despite academic institutions moving away from live animal use, third-party training centers might want to offer these models because they rely on enrollment fees and may prioritize what draws in trainees rather than what provides the most effective and ethical training.
Some trainees may place too much emphasis on whether a simulation model replicates tissue feel and bleeding, rather than focusing on how well it supports skill development that translates to real clinical practice. Crucially, preference does not equate to educational benefit: “[a] learner’s preference for a certain modality does not mean that it is educationally more beneficial compared to another modality.”1 Nevertheless, profit-driven centers may continue offering animal-based courses simply because the market exists, not because they are superior. Additionally, trainees might not be aware that alternative simulation models are available to mimic tissue feel and bleeding, including 3D printed models,2 perfused human organ models,3 and perfused cadavers.4
Lastly, it is important to consider that these third-party centers are not subject to the same level of transparency or public oversight compared to public institutions. In most states, animal use at public universities can be investigated through open records requests, which may reveal how often animals are used, the species involved, the training procedures performed, and the methods of euthanasia. While highly imperfect, this system offers some degree of transparency. However, private, for-profit centers lack this level of transparency, which might embolden them to use animals because they have little fear of public scrutiny.
Why This Matters
Third-party centers and companies may use hundreds or even thousands of animals annually, and new facilities continue to open worldwide. Along with animal welfare concerns, the expansion of these centers and their training methods should be scrutinized, since they are responsible for educating future medical professionals. As more academic institutions outsource medical training to third-party centers, the quality of education at these centers directly influences the quality of future patient care.
Many efforts are underway to raise awareness among trainees, educators, and the broader medical community about human-relevant training methods in medical education. However, there has been little discussion about the use of animals at third-party training centers. More on this topic should be explored, as conversations about the ethics of medical training at these centers are vital to ensure the welfare of animals and future patients of trainees who attend these courses. Just as many academic institutions now incorporate effective non-animal models—such as perfused cadavers, augmented reality tools, and systems providing real-time performance feedback—third-party facilities can do the same. Given their important role in supplementing medical training, these third-party training centers have the potential to provide a necessary extension of academic medical training, but only if they exclusively use high-quality, human-relevant, ethical simulation models.
- Swain CS, Cohen HML, Helgesson G, Rickard RF, Karlgren K. A systematic review of live animal use as a simulation modality (“Live Tissue Training”) in the emergency management of trauma. J Surg Educ. 2023;80(9):1320-1339. doi:10.1016/j.jsurg.2023.06.018
- Jiang Y, Jiang H, Yang Z, Li Y. The current application of 3D printing simulator in surgical training. Front Med (Lausanne). 2024;11:1443024. doi:10.3389/fmed.2024.1443024
- Höbner LM, Staartjes VE, Colombo E, et al. How we do it: the Zurich Microsurgery Lab technique for placenta preparation. Acta Neurochir. 2023;165:3821-3824. doi.org/10.1007/s00701-023-05847-5
- McClelland D, O’Connor LP, Barnard J, et al. The utilization of perfused cadaver simulation in urologic training: a pilot study. BMC Urol. 2021;21(1):134. doi:10.1186/s12894-021-00895-4
