What do Pets Want? Competent Vets!

By: Jennifer (Jennie) Hodgson

Introduction

Since the early 2000s, veterinary medical education has followed other health care professions and recognized the need for a greater focus on outcomes and the identified competencies required of Day-1 veterinary practitioners. Early efforts to more specifically identify these competencies included workshops outputs¹ as well as inclusions of competencies to accreditation standards²; but these were a list of competencies that were often confusing, did not have shared mental models, and/or were not widely adopted. More recently, a number of competency frameworks have been developed for veterinary education^3,4 that were comprehensive in nature and include supporting milestones and Entrustable Professional Activities^5-7. The term competency based veterinary education (CBVE) was also coined at this time, and, similar to CBME, has become the umbrella term under which this movement is occurring. With these tools in hand it could be argued that veterinary education is now well placed to embrace CBVE and have widespread, uniform adoption and implementation. However, there are a number of challenges as well as opportunities that should be recognized as we move towards implementing CBVE in our veterinary programs worldwide.    

Going Forward: Challenges and Opportunities

Do we Need CBVE?

In a recent paper, Danielson⁸ questioned whether we had evidence to support the need for implementation of CBVE. In other words, are our veterinary graduates already competent or are there sufficient shortcomings in the medical competence of veterinarians to necessitate a change to the way we teach our students? Although there is some evidence in the literature that new graduates do not feel fully prepared for Day-1 practice,^9,10 these are perceptions and not a direct measure of the competence of the new graduate per se. Furthermore, in veterinary medicine we do not have systems in place that assess competence of specific activities post-graduation (e.g., surgery, anesthesia, radiology) or demonstration of enhanced patient outcomes as a result of an educational intervention. Yet, in a recent paper by van Melle and colleagues,¹¹ they argued that outcomes should be thought of more broadly and across the continuum of time from proximal, program related outcomes (e.g., enhanced quality of feedback, learners who demonstrate self-regulated learning) to those outcomes taking more time to develop (e.g., enhanced readiness for practices, ease of transition into practice) to more distal, systems-based outcomes (e.g., enhanced patient care). Many of these outcomes could be measured in veterinary education, especially those more proximal, program-related outcomes. Therefore, to help answer the question \”Is CBVE needed?\”, veterinary programs that are considering adopting CBVE should be encouraged to evaluate these outcomes before and after implementation to determine if this new educational model is shifting the needle on these important outcome metrics.

Is Less More?

If widespread implementation of CBVE is a primary goal for veterinary education, it must be done with the context and resources that are available for veterinary education at the forefront of its adoption. In North America, the typical Doctor of Veterinary Medicine (DVM) Program is a four-year professional degree, which licenses the graduate to practice general medicine, surgery and anesthesia on a range of domestic species (e.g., dogs, cats, horses, cows, pigs and pocket pets). There is no requirement to undertake advanced training after graduation though a proportion of graduates do enter specialist training programs (residencies) such as in veterinary oncology, dentistry, microbiology, radiology, surgery, emergency and critical care etc. These residency training programs are usually located in large, University-operated veterinary teaching hospitals (VTH) that are focused on providing secondary and tertiary care for patients, and are the same location where most of the teaching of DVM students occurs. It is understandable then that tensions may exist between the educational needs of the DVM students and that of the residents, as well as the service needs of the specialist centers at the VTH’s. These tensions can spill over to the identified competencies taught and assessed in these locations. For example, with the recent interest in adoption of CBVE, there has been the temptation to develop additional list of competencies for specific areas of specialty^12-14, which if adopted for all specialty areas would result in the potential expansion to hundreds, if not thousands, of individual competencies should they all be combined.  While identification of additional, more granular competencies may be helpful to a point, a wholesale approach of adding required competencies identified by specialist groups is neither constructive nor sustainable. Given the breadth of expectations for veterinary graduates, as well as the time frame in which we expect these to be developed, care must be taken by veterinary programs to focus teaching efforts, as well as resources, on the development of essential knowledge, skills and abilities of a Day-1 graduate and the demonstration that these competencies have been achieved. 

CBVE for Dummies!

Considerations for resources required for implementation of CBVE should not only be focused on students, but also faculty. I was struck by a recent blog post by Kelly Caverzagie, who noted that “despite a decades long, worldwide journey…..our seeming inability to make considerable progress on a large scale” for implementation of CBME. He acknowledged that this is likely to be a multifactorial problem, and listed a number of the complex issues that could be factoring into this outcome, but he also noted that one potentially daunting barrier for institutions not innovating in CBME may be because the “frontline medical educators…..are not part of the conversation”. This is an equally important observation for veterinary education! Many of the drivers of both our pre-clinical as well as clinical educational models are similar (e.g., dwindling faculty/staff numbers, large teaching hospitals, focus on financial aspects), but veterinary educational programs often have significantly less resources (smaller budgets, fewer faculty, less facilities, etc.) than their medical school counterparts, while teaching the same number of students/institutions and who are expecting to be educated to become competent veterinarians.  It could also be argued that the impact of the COVID-19 pandemic has been just as great on veterinarians and veterinary education, with a boom in pet ownership resulting in long hours and excess case-loads for many of our frontline clinicians. Asking these clinicians, as well as our pre-clinical faculty, to fully embrace CBVE at this time and to make substantial curricular changes is neither practical, desirable nor sustainable.

Dr. Caverzagie’s suggestions for CBME for Dummies is also just what CBVE needs to keep us moving forward, but within the context of the current times.  To this end, the next edition of our triannual CBVE Newsletter will be focused on “CBVE – Back to Basics”. We are looking at ways to explain the essential, core components of CBVE more simply, so that their implementation does not appear overwhelming. Can we identify “uncomplicated” approaches to implement each component, emphasizing that all components do not need to be adopted at the same time or in the same order for all programs? Can we better clarify the inter-relationships between competencies, milestones and EPAs, a concept which tends to confuse many in veterinary education? Can we identify small changes to pre-clinical curricula that could be implemented that will help move the needle forward, but not break the bank (sorry about mixing metaphors and idioms!)? While many in veterinary education are currently excited about adopting CBVE, and the positive impact this model may have on our future graduates, it is essential we encourage implementation in a way that embraces the context, resources and culture of veterinary education.

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About the author: Jennifer (Jennie) L. Hodgson, BVSc, PhD, MRCVS, DACVM is Associate Dean, Professional Programs and Professor of Microbiology at the Virginia-Maryland College of Veterinary Medicine, Virginia Tech. In 2022, she was appointed as co-chair of the Veterinary School Accreditation and Advisory Committee (VSAAC) of the Australasian Veterinary Boards Council.

References:

1.Shung G, Osburn BI. The North American Veterinary Medical Education Consortium (NAVMEC) looks to veterinary education for the future. Roadmap for veterinary medical education in the 21st century: responsive, collaborative, flexible. J Vet Med Educ. 2011;38(4):320-7. doi: 10.3138/jvme.38.4.320

2. AVMA. COE Accreditation Policies and Procedures: requirements [Internet] https://www.avma.org/education/accreditation/colleges/coe-accreditation-policies-and-procedures-requirements: Schaumberg (IL): The Association, 2021; 2021 [updated March 2021. Available from: https://www.avma.org/education/accreditation/colleges/coe-accreditation-policies-and-procedures-requirements.

3. Bok H, G.J., Jaarsma D, A.D.C., Teunissen PW, van der Vleuten CPM, van Buekelen P. Development and validation of a competency framework for veterinarians. J Vet Med Educ. 2011;38(3):262-9. doi: 10.3138/jvme.38.3.262

4. Matthew SM, Bok H, G.J., Chaney KP, Read EK, Hodgson JL, Rush BR, et al. Collaborative development of a shared framework for competency-based veterinary education. J Vet Med Educ. 2020;47(5):578-93. doi:10.3138/jvme.2019-0082

5. Molgaard LK, Chaney KP, Bok H, G.J., Read EK, Hodgson JL, Salisbury SK, et al. Development of core entrustable professional activities linked to a competency-based veterinary education framework. Med Teach. 2019;41(12):1404-10. doi: https://doi.org/10.1080/0142159X.2019.1643834

6.  Favier RP, Godijn M, Bok H, G.J. Identifying entrustable professional activities for surgical skills training in companion animal health. Vet Rec. 2019:pii: vetrec-2019-105386SW. doi: https://doi.org/10.1136/vr.105386

7.  Duijn CC, ten Cate O, Kremer WD, Bok H, G.J. The development of entrustable professional activities for competency-based veterinary education in farm animal health. J Vet Med Educ. 2019;46(2):218-24. doi: doi.org/10.3138/jvme.0617-073r

8. Danielsen JA. Key assumptions underlying a competency-based approach to medical sciences education, and their applicability to veterinary medical education. Frontiers in Veterinary Science. 2021;8:1-7. doi: 10.3389/fvets.2021.688457

9. Duijn CC, Bok H, G.J., ten Cate O, Kremer WD. Qualified but not yet fully competent: perceptions of recent veterinary graduates on their day-one skills. Vet Rec. 2019:ii: vetrec-2018-105329. doi: 10.1136/vr.105329.

10. Lavictoire S. Education, licensing, ad the expanding scope of veterinary practice; members expressing their views. Can Vet J. 2003;44:282-4. PubMed Link

11. van Melle E, Hall AK, Schumacher DJ, Kinnear B, Gruppen LD, Thoma, Brent, et al. Capturing outcomes of compentency-based medical education: the call and the challenge. Med Teach. 2021;43(7):794-800. doi:10.1080/0142159X.2021.1925640

12. Snowden KF, Krecek RC, Bowman DD. AAVP recommendations for core competency standards relating to parasitological knowledge and skills. J Vet Med Educ. 2016;43(4):344-8. doi:10.3138/jvme.0715-104R1

13. Hamilton K, Middleton JL, Pattamakaew S, Khattiya R, Jainonthee C, Meeyam T, et al. Mapping veterinary curricula to enhance World Organization for Animal Health (OIE) Day 1 competence of veterinary graduates. J Vet Med Educ. 2020;47(s1):75-82. doi:10.3138/jvme-2019-0109

14.  Newman AW, Moller CA, Evans SJM, Viall A, Baker K, Schaefer DMW. American Society for Veterinary Clinical Pathology – recommended clinical pathology competencies for graduating veterinarians. J Vet Med Educ. 2021:e20210004. doi:10.3138/jvme-2021-0004

Cartoon by W.B. Park, from CartoonStock.com

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