EPAs for Competency Based Veterinary Education (CBVE) for workplace-based assessment

By: Laura Molgaard

I work at the University of Minnesota College of Veterinary Medicine and I’ve had the opportunity to pilot some of the resources mentioned below in our DVM program. In particular, I’ve been interested in the use of EPAs to increase the frequency and quality of feedback our students receive as a part of workplace-based training and assessment.  Our curriculum, like many others, consists of six semesters of classroom and laboratory instruction in basic and clinical sciences and professional development, followed by three semesters (about 13 months) of clinical rotations in our veterinary teaching hospital and out in the community. As a former associate dean, I frequently heard from students that they did not receive feedback at all or that they received very general feedback such as “good job, thanks for your help, keep reading to expand your knowledge base”.  In fact, in a 2018 survey of our students, students reported they received feedback in only 10-25% of their clinical rotations.

Veterinary medical education has been following in the footsteps of medical education in creation of Competency Based Medical Education (CBME) resources and implementation of these resources in various contexts. In 2018, the Competency-Based Veterinary Education (CBVE) Working Group, under the auspices of the American Association of Veterinary Medical Colleges (AAVMC), published the CBVE Framework¹ of 32 competencies organized under nine domains of competence as well as the core Entrustable Professional Activities (EPAs)² for the “day one” graduate.  About a year later, the group published CBVE milestones for each of the 32 competencies.  The genesis of this working group and the tools it developed was the shift in veterinary accreditation over the previous decade toward outcomes assessment and the desire for better tools for workplace-based assessment, in particular. 

Before I dive more deeply into CBVE, allow me to give some additional context about the health profession of veterinary medicine.  Veterinary education in North America is typically a four-year professional program that follows an undergraduate program relatively similar to a pre-med curriculum. The professional degree that results is the Doctor of Veterinary Medicine (DVM) degree. Unlike medical education, graduates are licensed to practice general medicine and surgery after the four-year professional program. A  smaller percentage continues on to complete advanced specialty training through  residency programs to become  board certified in subspecialities such as  veterinary oncology, surgery, radiology, etc. The CBVE tools were developed to assist with curriculum development or revision and assessment within the four-year professional program.

Later that year, we began to pilot the use of EPAs in select clinical services with the goal of evaluating the feasibility and acceptability of a short entrustment form in a busy clinical environment.  The scale we chose was:

1. Not ready to trust – Learner could not perform and observed only – I had to do it
2. Trust with constant guidance – Learner required step by step guidance – I had to talk them through it
3. Trust with intermittent guidance – Learner required direct supervision with intermittent guidance – I had to prompt them from time to time
4. Trust with on demand guidance – Leanern required on demand guidance – I needed to be there just in case
5. Trust with no guidance – Learner required minimal supervision, could trust to do on own if already graduated – I did not need to be there

This scale was followed by two narrative prompts that were chosen to shift raters and learners toward a growth mindset: “The student should keep doing…” and “To advance to the next level try…”.  We provided a short (~45 minute) training for raters (faculty, interns, residents and veterinary technicians/nurses) and a shorter (~10 minute) introduction to the learners.  We encouraged bidirectional initiation of the rating/feedback and created a survey to collect the ratings and narrative feedback.  We surveyed both learners and raters as to the perceived value of the feedback as well as the time it took to complete the process.

The pilot has continued and we are in the process of drafting a manuscript to more fully describe the process and the results, but I’ve presented the outcomes of the first pilot and will share the broach brushstrokes here.  The upshot is yes, we were able to increase the frequency and perceived value to both the learners and the raters. In fact, 73% of raters agreed or strongly agreed that the new process improved the quality of feedback they were able to provide and that the process took 2-5 minutes.  Learners had similarly positive experiences with 75% reporting they received reinforcing and corrective feedback (contrasted with the 10-25% who had previously reported receiving any feedback at all).

This pilot has since been expanded with the development of a dashboard for learners and faculty/administration to visualize student progress. We have also mapped our professional curriculum to the 32 competencies of the CBVE framework. Next steps include creation of a Longitudinal Integrated Clerkship based on the use of EPAs as the core assessment tool. We are also interested in developing a Clinical Competency Committee.I look forward to sharing more details about our journey in the med ed literature.

About the author:
Laura Molgaard, DMV, is Dean of the College of Veterinary Medicine and a member of the Association of American Veterinary Medical Colleges (AAVMC) Competency-Based Veterinary Education Advocate Working Group

References

1.Matthew SM et al. 2020. Collaborative development of a shared framework for competency-based veterinary education. Journal of veterinary medical education. 2020; 47(5), pp.578-593.

2. Molgaard, LK et al. Development of core entrustable professional activities linked to a competency-based veterinary education framework. Medical Teacher. 2019;41(12), pp.1404-1410.

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