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I. History, Description and Charge of the ECFVG |  Top |
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In 1971, the House of Delegates approved a "Procedure for Recognizing Graduates of Colleges of Veterinary Medicine Outside the United States and Canada." That procedure included a provision for the formation of "a special committee to be named the Educational Commission for Foreign Veterinary Graduates, advisory to the Council on Education, which shall be appointed by the AVMA Executive Board to maintain continuing surveillance over procedures for acceptance of graduates of colleges of veterinary medicine outside the United States and Canada." Today, the ECFVG continues to carry out its two-part charge:
- To evaluate the professional competence of graduates of non-AVMA/Council on Education-accredited colleges of veterinary medicine listed by the AVMA, to the benefit of such graduates and of the state and provincial veterinary licensing agencies, and of other concerned parties; and
- To allow utilization of ECFVG examinations and other assessment resources to evaluate the professional competence of graduates of AVMA/Council on Education-accredited colleges of veterinary medicine when such utilization is to the benefit of the state and provincial veterinary licensing agencies, and other concerned parties.
Recommendations pertaining to changes in ECFVG policies are forwarded to the AVMA Executive Board for consideration and approval. Decisions related to candidates and internal operational policies such as the Clinical Proficiency Examination Manual of Administration, petitioning processes, and application and evaluation forms are made by the ECFVG alone and are independent of the AVMA. Further, such decisions are not influenced by the partner organization or its recognized affiliate organizations. Since the inception of the current certification program (January 1, 1973) through December 31, 2006, the ECFVG has awarded more than 3,700 certificates.
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II. AVMA-listed Veterinary Colleges | Top |
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An AVMA-listed veterinary college is any non-AVMA-accredited college outside the United States or Canada that is recognized by the World Health Organization or the government of its own country, and whose graduates are eligible to practice in that country. The World Health Organization last published the World Directory of Veterinary Schools in 1973. Additional listed schools also are described in the World Veterinary Directory 1991, edited by the World Veterinary Association in cooperation with the Food and Agriculture Organization of the United Nations, the World Health Organization, and the Office International des Epizootics. Should a graduate of a non-listed college apply to the ECFVG program, the ECFVG Coordinator requests that the college obtain a letter from the federal Ministry of Education indicating that the college is recognized by the government of that country and that its graduates are eligible to practice veterinary medicine within that country. After the ECFVG reviews and approves necessary documentation, the college is added to the list. A graduate of a non-listed veterinary college cannot enroll in the ECFVG program until the college becomes listed.
Veterinary Colleges of the World (PDF)
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III. Overview of the ECFVG Certification Program | Top |
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An ECFVG certificate may be accepted by state veterinary medical licensing agencies as fulfilling the educational prerequisite for state licensure. The majority of states require graduates of non-AVMA accredited schools to hold an ECFVG certificate. However, because licensing requirements can change, the ECFVG and AVMA urge all veterinarians to contact the licensing agency in the state in which they wish to become licensed to determine current requirements, including educational prerequisites.
The ECFVG certification program comprises 4 steps, each one designed to build from the previous. The purpose of the first step is to confirm an applicant's veterinary college credentials. The second step is designed to assess a candidate's English language ability. The purpose of the third step is to assess a candidate's basic and clinical veterinary science knowledge, whereas the purpose of the fourth and final step is to assess a candidate's hands-on clinical veterinary medical skills.
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IV. Specific Steps of the ECFVG Certification Program | Top |
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To register in the ECFVG certification program, an applicant must submit the following to the ECFVG office:
- A completed and notarized ECFVG application form (Appendix 1) that must include a passport, green card, or Social Security card number.
- Two passport-sized photographs of the applicant.
- Certified, notarized, or official (issued directly by school) photocopies of the applicant's veterinary college diploma and transcripts (for each year), both in the language of issuance and as a certified English translation if necessary. Provisional Certificates and Certificates of Graduation are unacceptable for ECFVG program purposes. If the applicant is enrolled in the final year of study at an AVMA-listed veterinary college (see Veterinary Colleges of the World [PDF]), a letter from an official of that college must also be submitted stating that the applicant will graduate within the year.
- Payment of $1,000.00 (USD; $275.00 ECFVG program application fee; $725.00 Quality Assurance Program [QAP] fee) can be made by credit card (Visa or MasterCard), by personal check from a US bank only, or by cashier's check or money order. Checks or money orders should be made payable to the AVMA. If paying by credit card, please submit the following information with your application:
- Type of credit card (Visa or MasterCard)
- Credit card number
- Expiration date
- Name and billing address for credit card if different from name and address on ECFVG application
All items must be sent to: ECFVG, American Veterinary Medical Association, 1931 N Meacham Road, Suite 100, Schaumburg, IL 60173-4360, USA.
If a candidate wishes to withdraw from the program within 60 days after applying, the entire fee will be refunded upon written or E-mail request.
The original registration fee is valid for two years. To remain active in the program, candidates must re-register every two years by notifying the ECFVG and paying 10% of the current program application fee. Files of candidates who do not reregister in the ECFVG certification program will be made inactive. An inactive file may be reactivated within eight years upon the written request of the candidate and payment of all past-due re-registration fees. Inactive candidate files older than eight years will be destroyed. Future entrance into the ECFVG certification program would require new registration according to guidelines currently in effect.
The ECFVG verifies all applicants' educational credentials. The ECFVG Coordinator sends a "certification of graduation" form (Appendix 2) (PDF) with the applicant's photograph to the dean of the veterinary college from which the applicant graduated. The dean or other college official must verify the applicant's identification and graduation date and return the completed form with the college seal affixed to the ECFVG office. Applicants may proceed with the other steps of the program while verification is being obtained.
Once enrolled, candidates must submit address and name change requests in writing or E-mail, listing both the old and new address, or old and new name, and any relevant changes in telephone numbers or E-mail addresses. Name changes must be substantiated with a copy of appropriate legal documents.
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ECFVG English Language Requirements
Effective July 1, 2005
To complete Step 2, non-native English speaking candidates must provide the ECFVG with proof of comprehension and ability to communicate in the English language by attaining passing scores on the TOEFL, TWE, and TSE, or, beginning in September 2005, the internet-based TOEFL, or the IELTS, or the CAEL Assessment.
The TOEFL, TWE, and TSE and the internet-based TOEFL are offered by Educational Testing Service (ETS) at TOEFL/TWE & TSE Services, PO Box 6151, Princeton, NJ 08541-6151 (Web site: http://www.toefl.org/; telephone: 609-921-9000).
For ECFVG program purposes, candidates choosing to take the TOEFL (computer- or internet-based) MUST take each subsection of the TOEFL. Please note that the TWE is contained within the computer-based TOEFL as the essay rating, whereas the TSE is a separate examination. Also note that in September 2005, ETS will begin a phased introduction of its new internet-based (iB) TOEFL (see www.ets.org/toefl/nextgen/), which comprises four sections: listening, reading, writing, and speaking. Candidates taking the iB-TOEFL will not be required to take the TSE. Once the iB-TOEFL is introduced in a given country, ETS will no longer administer the computer-based TOEFL or the separate TSE. Candidates must contact ETS for information regarding the new iB-TOEFL or the computer-based TOEFL/TWE and TSE, including dates and location of examinations, fees, and application procedures.
For ECFVG program purposes, the passing score on the computer-based TOEFL is 213 with at least 25 points in listening comprehension (section 1); the passing score on the TWE (TOEFL essay section) is 4.0; and the passing score on the TSE is 50. The passing score on the new internet-based TOEFL is 80 overall, with at least a 26 in listening, a 17 in writing, and a 26 in speaking; the TSE is not required for candidates taking the new internet-based TOEFL. The ECFVG CANNOT accept section scores from separate computer-based TOEFL/TWE or internet-based TOEFL exam administrations; candidates MUST achieve at least the minimum passing scores for all required sections of the computer-based TOEFL/TWE or internet-based TOEFL on the same exam administration.
The ECFVG requires original score reports directly from ETS. ECFVG candidates must request their TOEFL/TWE and TSE scores or internet-based TOEFL scores be reported directly to ECFVG by ETS. Please use institution code 1212 when requesting score reports. Because ETS only maintains score reports for two years from the date of examination, candidates should plan accordingly to ensure that score reports do not expire before requesting that they be submitted to the ECFVG. Moreover, the ECFVG office cannot hold score reports longer than two years for individuals who are not currently enrolled in the ECFVG certification program. The ECFVG will continue to accept computer-based TOEFL/TWE and separate TSE scores until ETS discontinues those examinations worldwide.
The International English Language Testing System (IELTS) is administered by the University of Cambridge Local Examinations Syndicate, the British Council, and IDE Education Australia. For information in North America, contact IELTS Inc at 100 East Corson St, Suite 200, Pasadena, CA 91103 (Web site: www.ielts.org; telephone: 626-564-2954).
For ECFVG program purposes, candidates choosing to take the IELTS MUST take the academic IELTS. The passing score on the academic IELTS is 6.5 (overall band score), with at least a 6.5 in the listening band, a 6.0 in the writing band, and a 7.0 in the speaking band. The ECFVG CANNOT accept section scores from separate exam administrations; candidates MUST achieve at least the minimum passing scores for all required sections of the IELTS on the same exam administration. The ECFVG requires original score reports directly from IELTS Inc.
The Canadian Academic English Language (CAEL) Assessment is administered by Carleton University. Please contact the CAEL Assessment Testing Office, Language Assessment and Testing Research Unit, 124 Paterson Hall, Carleton University, 1125 Colonel By Drive, Ottawa, Ontario, Canada K1S 5B6 (Web site: www.cael.ca; telephone: 613-520-2600, ext 2271).
For ECFVG program purposes, candidates choosing to take the CAEL Assessment MUST take each subsection of the CAEL Assessment. The passing score on the CAEL Assessment is 60 (overall score), with at least a 60 in the listening band, a 50 in the writing band, and a 60 in the speaking band. The ECFVG CANNOT accept section scores from separate exam administrations; candidates MUST achieve at least the minimum passing scores for all required sections of the CAEL Assessment on the same exam administration. The ECFVG requires original score reports directly from the CAEL Assessment Testing Office.
For candidates whose native language (ie, the common language of an individual's country of birth) is English, the English language examinations may be waived. To do so, eligible candidates must provide documentation of at least three years full-time attendance at a secondary (high) school at which the complete language of instruction was English. Acceptable documentation includes a letter directly from school officials stating dates of attendance and verifying that the complete language of instruction was English or, for graduates of US high schools, a certified, notarized, or official copy of the final diploma or transcript. A degree from an English-speaking college or university is not considered adequate proof of English language ability.
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| Step 3 — Basic and clinical sciences knowledge |
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To complete Step 3, candidates must provide proof of attaining a passing score on the Basic and Clinical Sciences Examination (BCSE; after April 2007), North American Veterinary Licensing Examination (NAVLE; on or before April 2007) or, prior to 2000, the National Board Examination (NBE) and Clinical Competency Test (CCT) in veterinary medicine.
The AVMA owns and administers the BCSE, which is a four-hour computer-based examination consisting of 200 multiple-choice questions designed to help assess basic and clinical veterinary sciences knowledge. Complete information on the BCSE, including application procedures and deadlines, can be found in the BCSE Candidate Bulletin.
For information regarding the NAVLE, which is a licensing examination, please contact the National Board of Veterinary Medical Examiners (NBVME), PO Box 1356, Bismarck, ND 58502 (Web site: www.nbvme.org; telephone: 701-224-0332). |
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| Step 4 — Clinical skills assessment |
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As of May 1, 1987, only the clinical proficiency examination (CPE) approved by the ECFVG or one year of postgraduate evaluated clinical experience at an AVMA-accredited veterinary college (see Veterinary Colleges Accredited by the AVMA) will meet the requirements for assessment of hands-on clinical skills. Please note that as of July 1, 2007, only the CPE will meet the requirements for assessment of hands-on clinical skills. Candidates intending to complete one year of postgraduate evaluated clinical experience must successfully complete all requirements before July 1, 2007. The Canadian clinical examination will be accepted as equivalent to the CPE currently approved by ECFVG for purposes of reciprocity.
To complete Step 4, candidates must provide proof of attaining a passing score on the CPE or, through July 1, 2007, successful completion of a postgraduate evaluated clinical year at an AVMA-accredited, ECFVG-approved college of veterinary medicine.
Eligibility—All candidates will be notified of their Step 4 eligibility by letter from the ECFVG Coordinator (Appendix 3). ECFVG candidates who are graduates of AVMA-listed veterinary colleges (see Veterinary Colleges of the World [PDF]) become eligible to apply for and take the CPE after completing Steps 1, 2, and 3 of the certification program (Appendix 4). Candidates who register in the ECFVG program during their final year of studies at an AVMA-listed veterinary college become eligible to apply for the CPE after completing Steps 2 and 3 of the ECFVG certification program but cannot select or be assigned to a CPE date prior to their anticipated graduation date (Appendix 5). Furthermore, Step 1 must be completed before the first day of the assigned CPE, and Step 1 is considered complete only after the ECFVG processes copies of the candidate's veterinary college diploma and final transcripts. ECFVG policy also states that this documentation must be received not later than 60 days prior to the date of the assigned CPE, so candidates should plan accordingly. Additionally, candidates who complete any portion of their clinical education at an AVMA-accredited veterinary college (see Veterinary Colleges Accredited by the AVMA) cannot take the CPE administered at that college.
CPE format—The CPE is a 3.5-day, 7-section, hands-on clinical skills examination, administered by the faculty of a college of veterinary medicine or other authorized testing institution. The skill level expected for a passing grade on each of the 7 sections of the CPE is that of an entry-level graduate of an accredited veterinary college. Only well-prepared candidates will be able to pass the CPE.
The 7 sections of the CPE include: anesthesia, clinical and anatomic pathology, equine practice, food animal practice, small animal practice, radiology, and surgery. The CPE Manual of Administration describes specific sections and skills to be assessed and serves as the guide for administering the CPE to all candidates. All sites offering the CPE must adhere to the standards set forth in the CPE Manual and 2 other quality assurance documents (Appendix 6 and 7). Examination sites reserve the right to accept no more than 8 qualified applicants for the examination and to cancel an examination if less than 4 candidates apply.
Rules of Conduct for the CPE—The ECFVG has established Rules of Conduct to govern administration of the CPE to ensure that no examinee or group of examinees receives unfair advantage on the examination, inadvertently or otherwise.
If there is a reason to believe that the integrity of the examination process is jeopardized, the ECFVG may invalidate all or any part of a CPE administration. If information indicates that continued testing would jeopardize the security of examination materials or the integrity of scores, the ECFVG reserves the right to suspend or cancel any CPE administration.
CPE site team members (ie, coordinators, examiners, technicians, and assistants) monitor all sections of the CPE. If CPE site team members observe a candidate violating the Rules of Conduct or engaging in other forms of irregular behavior during a CPE, the team members will not necessarily advise the candidate at the time of the examination, but shall report such incidents to the ECFVG. Each report shall be fully investigated.
By applying to take the CPE, a candidate agrees to the following Rules of Conduct:
- You are the person named on the CPE application.
- You will place in a locker or cubicle or other designated area all personal belongings, including cellular telephones, watches with computer communication and/or memory capability, pagers, personal digital assistants (PDAs), formulas, study materials, notes, papers, and your purse or wallet, before you enter the secure testing areas.
- You will not use a telephone at any time while you are in the secure areas.
- You will not give, receive, or obtain any form of unauthorized assistance during the testing session, including any breaks.
- You will not have in your possession any formulas, study materials, notes, papers, or electronic devices of any kind unless you are out of the secure testing areas of the CPE site.
- You will not remove materials in any form (written, printed, recorded, or any other type) from the secure testing area unless instructed to do so by the examiners.
- You understand and acknowledge that all examination materials remain the property of the CPE site and ECFVG, and you will maintain the confidentiality of the case content for all seven sections of the CPE. You will not reproduce or attempt to reproduce examination materials through memorization or any other means, nor will you provide information relating to examination content that may give or attempt to give unfair advantage to individuals who may be taking the examination, including, without limitation, by posting information regarding examination content on the Internet.
Unless specifically authorized, candidates may not bring personal belongings into secure testing areas of the CPE site. Failure to follow these rules shall constitute a violation of the Rules of Conduct for the administration of the CPE and may lead to adverse action regarding a candidate's examination. For the CPE, candidates should understand that the entire testing session over the 3.5- to 4-day testing period, including all breaks, is considered a closed and secure testing session, and that the entire CPE site, including any on-site lunch room, break rooms, and restrooms, is a secure testing area. Therefore the rules regarding unauthorized possession during the CPE extend to lunch, if lunch is provided on site, and all breaks.
For the CPE, unauthorized personal belongings include, but are not limited to:
- mechanical or electronic devices other than simple calculators, such as cellular telephones, personal digital assistants (PDAs), watches with computer communication and/or memory capability, electronic paging devices, recording or filming devices, radios;
- outerwear, such as coats, jackets, head wear, gloves;
- book bags, backpacks, handbags, briefcases, wallets; and
- books, notes, study materials, or scratch paper.
If candidates bring any personal belongings to the CPE site, they must store them in a designated locker or storage cubicle or other designated area as directed by the CPE site team. All stored mechanical or electronic devices must be turned off. Upon reasonable suspicion, a candidate's personal belongings and their contents may be inspected. Any materials that reasonably appear to be reproductions of any case material specific for the CPE administration in which a candidate is participating will be confiscated. Making notes of any kind during the CPE, except on the materials provided by the CPE site for this purpose, is not permitted. If candidates have any questions regarding the appropriateness of personal belongings to be brought into the CPE site, contact the ECFVG or a CPE site team member prior to admission.
Admission to the CPE—When candidates arrive at the CPE site for orientation and check in, they must present a photo ID with signature. Acceptable forms of identification include the following forms of unexpired identification:
- passport;
- driver's license;
- national identity card; or
- other form of unexpired, government-issued identification.
The identification must contain both the candidate's signature and photograph. If a candidate does not bring acceptable identification, he/she will not be admitted to the CPE. In that event, the candidate will be required to reschedule the CPE in accordance with current ECFVG policy.
The candidate's name as it appears on his/her CPE application must match the name on the form(s) of identification exactly. If a candidate's name listed on his/her CPE application is not correct, contact the ECFVG office immediately at ECFVG@avma.org or 800-248-2862, ext 6682 or 6623.
Test Centers and Testing Conditions—The time and location for arrival at the CPE site for orientation and check in will be sent to each candidate by US mail prior to the administration of the examination. If a candidate arrives late, he/she will not be admitted, and will have to reschedule the test date in accordance with current ECFVG policy.
At the time of check-in, candidates will be required to present unexpired identification. Prior to beginning each day of the examination, candidates will be directed to a small storage cubicle or locker or other designated area in which they must place personal belongings. These cubicles may not be secure, so do not bring valuables.
In addition, candidates should please note the following:
- You should bring only the equipment specified for each section within the CPE Manual of Administration; all other equipment is provided at the CPE
- You should wear comfortable, professional clothing.
- There are no waiting facilities for family and friends at the center; plan to meet them elsewhere after the examination ends.
- CPE site team members (wearing name tags) will direct you throughout each day of the CPE, and their instructions should be followed at all times.
There will be an on-site orientation to each section of the CPE to acquaint candidates with specific procedures and regulations.
Once candidates enter the secure testing area of the CPE site, they may not leave that area until directed to do so by a member of the CPE site team. Breaks, including a lunch break, are provided. CPE site team members will direct candidates to any on-site break and lunch rooms.
Candidates may not discuss the cases with fellow examinees at any time, and conversation among examinees in any language other than English is prohibited at all times. CPE site team members will monitor all examinee activity. See "Irregular Behavior" below.
CPE site team members are not authorized to answer questions from examinees regarding examination content or scoring.
Should a candidate wish to file a concern regarding the CPE testing experience, he/she may do so at the site on the test day(s). If a candidate does not file a report at the site, he/she must notify the ECFVG office in writing within three weeks of the final day of the administration of the CPE. Concerns that are reported in this way will be investigated in accordance with the current ECFVG Complaints Procedure (available at www.avma.org/education/ecfvg/default.asp#complaints).
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Note: Visitors as approved by the ECFVG, may, on some occasions, be observing a CPE in progress. Other than site evaluators, they will be given no information regarding examinee identity or performance and will have no interaction with examinees. |
Irregular Behavior—Irregular behavior consists of any action by CPE candidates or others that subverts or attempts to subvert the examination process, including, without limitation:
- Falsification of information on the application form, including additional documentation, or failure to provide the ECFVG with information material to your application.
- Impersonating an examinee or engaging someone else to take the examination for you
- Giving, receiving, or obtaining unauthorized assistance during the examination, or attempting to do so.
- Unauthorized possession, reproduction, or disclosure of any materials, including, but not limited to, examination cases, before, during, or after the examination.
- Making notes of any kind during an examination except on the writing materials provided by the CPE for that purpose.
- Disruptive or unprofessional behavior at a CPE site.
- Offering any benefit to any CPE site team member or agent of the ECFVG in return for any right, privilege, or benefit which is not usually granted by the ECFVG to other similarly situated candidates.
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NOTE: Talking to another examinee during the examination may be reported as evidence of giving, receiving, or obtaining unauthorized assistance. |
If a candidate is determined to have failed to abide by the Rules of Conduct of the ECFVG or otherwise to have engaged in any form of irregular behavior, the ECFVG may terminate the candidate's participation in an examination, invalidate the results of an examination, withhold or revoke the candidate's scores or certification, bar the candidate's participation in future examinations, and/or take other appropriate adverse action. In addition, such determination shall become part of the candidate's permanent ECFVG record and the fact of such determination may be provided to third parties that receive or have received verification of ECFVG status. Such information may also be provided to other legitimately interested entities.
Candidates also should understand that the ECFVG may or may not require a candidate to retake one or more portions of the ECFVG if presented with sufficient evidence that the security of the examination has been compromised, notwithstanding the absence of any evidence of a candidate's personal involvement in such activities.
Appeal Process—Candidates determined to have violated the Rules or Conduct or otherwise engaged in irregular behavior may appeal the decision by following the current ECFVG Appeal Procedure (http://www.avma.org/education/ecfvg/default.asp#appeal).
Scoring the CPE—Passing scores (60 points or greater in all but Surgery; Surgery is graded as pass/fail) in all 7 sections of the CPE are required to pass the examination. A candidate who fails 4 or more sections of the examination or a candidate who fails 1, 2, or 3 sections and does not successfully pass each of those sections within 12 months of the original CPE attempt must repeat the entire CPE.
Each CPE site will report scores to the ECFVG office within 15 working days of the last day of the examination. The ECFVG office will notify candidates of their results (ie, pass or fail) on each section. An unsuccessful candidate may request feedback on failed sections from the ECFVG office. This information will assist the candidate in identifying his/her deficiencies and to devise a plan for upgrading. Candidates are prohibited from contacting examiners for feedback either during or following completion of the CPE.
Fees—The full CPE fee is $6,000 for ECFVG candidates initially registered in the certification program prior to January 1, 2006; $1,000 covers the maintenance of the CPE Quality Assurance Program (QAP), while the remaining $5,000 is forwarded to the site administering the CPE to help defray examiners' salaries, facility and equipment costs, animal procurement and maintenance costs, and other associated expenses. The full CPE fee is $5,000 for ECFVG candidates initially registered in the certification program on and after January 1, 2006 and who have paid a one-time ECFVG QAP on program registration. The full $5,000 CPE fee is forwarded to the site administering the CPE. The following fee schedule was developed in an effort to alleviate any financial burden on ECFVG candidates:
- For candidates initially registered in the certification program prior to January 1, 2006:
- $1,000 QAP fee (non-refundable/non-transferable)—$500 due when requesting an application, and the remaining balance due 60 days prior to examination.
- $5,000 CPE fee (non-refundable/non-transferable)—$500 due when returning a completed application, and the remaining balance due 60 days prior to examination.
- For candidates initially registered in the certification program on/after January 1, 2006:
- $5,000 CPE fee (non-refundable/non-transferable)—$500 due when requesting an application, $500 due when returning a completed application, and the remaining balance ($4,000) due 60 days prior to examination.
The final balance must be sent (post-marked) to the AVMA/ECFVG no later than 60 days prior to the scheduled exam. Final payment must be in the form of a cashier's check or money order made payable to the AVMA. Failure to pay this balance by the required deadline will result in forfeiture of all fees and loss of the reserved examination space.
For ECFVG candidates initially registered in the certification program prior to January 1, 2006, the fee to retake 1, 2, or 3 sections of the CPE is $1,500 per section; $250 covers the maintenance of the QAP, while the remaining $1,250 is forwarded to the site administering the CPE to help defray examiners' salaries, facility and equipment costs, animal procurement and maintenance costs, and other associated expenses. For ECFVG candidates initially registered in the certification program on or after January 1, 2006, the fee to retake 1, 2, or 3 sections of the CPE is $1,250 per section, with the total fee forwarded to the CPE site.
Application procedure—The ECFVG office will notify candidates in writing when they have attained CPE eligibility. After receiving written notification from the ECFVG office, eligible candidates must request a CPE application (Appendix 8) in writing. Candidates must include an initial deposit, in the form of a cashier's check or money order for $500 (non-refundable/non-transferable) payable to the AVMA, with the request. Once a candidate's request and initial deposit are processed, the Testing Coordinator will send the candidate a CPE application and Manual of Administration. Completed applications must be returned to the AVMA office together with the second deposit in the form of a cashier's check or money order for $500, made payable to the AVMA. Each candidate must submit the deposit and completed application in order to reserve an examination space. After processing a candidate's completed application, the Testing Coordinator will forward the candidate a letter confirming the date and location of the scheduled CPE. Examination dates are assigned on a first-come/first-serve basis.
Candidates retaking one or more sections must also request a CPE application in writing from the AVMA/ECFVG and must include a $250 non-refundable/non-transferable deposit for each section in the form of a cashier's check or money order made payable to AVMA. To reserve the examination space, candidates retaking sections must return the completed application to the AVMA/ECFVG together with the final payment in the form of a cashier's check or money order payable to AVMA in the amount of $1,250 per section for candidates initially registered in the ECFVG certification program prior to January 1, 2006 or $1,000 per section for candidates initially registered in the ECFVG certification program on or after January 1, 2006.
Rescheduling—Candidates may only reschedule an examination without forfeiture of all fees paid for medical reasons or a death in the family; written verification from a doctor or other appropriate authority is required to reschedule.
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Postgraduate Evaluated Clinical Year |
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Eligibility—ECFVG candidates are eligible to embark on a postgraduate evaluated clinical year (ECY) after completing Steps 1, 2, and 3 of the ECFVG certification program. All candidates will be notified of their Step 4 eligibility by letter from the ECFVG Coordinator, which includes Guidelines for the Postgraduate Evalutated Clinical Year (Appendix 3). Please note that beginning July 1, 2007, the ECY will no longer be accepted by the ECFVG as meeting the requirements for Step 4 of the certification program. Candidates currently enrolled in ECY programs will have until July 1, 2007 to complete the ECY and have it count as the final step towards certification. Sites can continue to admit ECFVG candidates into ECY programs as long as the program is structured to allow candidates to finish prior to July 1, 2007. The ECFVG encourages ECY sites to promote and offer Instructional Clinical Years for those candidates who need the additional educational experience to be successful in the CPE.
ECY format—To fulfill Step 4 of the certification program, a candidate may elect to participate in a postgraduate evaluated clinical year (ECY) rather than take the CPE. An ECY is an opportunity for a candidate to demonstrate, during one full calendar or academic year, hands-on clinical skills. The ECY is designed to evaluate comparable clinical skills as those taught during the entire curriculum at an AVMA-accredited college of veterinary medicine (see Veterinary Colleges Accredited by the AVMA). Skill level expected is that of an entry-level graduate of an AVMA-accredited college of veterinary medicine. The ECY must occur at an AVMA-accredited college of veterinary medicine after a candidate has graduated from an AVMA-listed college of veterinary medicine (see Veterinary Colleges of the World [PDF]).
During the period of evaluated clinical experience, both the candidate and the supervising veterinarian(s) should understand that:
- The evaluated clinical experience will occur during the actual day-to-day operation of the veterinary college, and is expected to provide opportunities for the candidate to demonstrate practical skills and knowledge in the management of a variety of clinical cases. The supervising veterinarian(s) is required to oversee the candidate's performance and to evaluate the candidate's ability to deal with actual cases in much the same manner he/she evaluates senior veterinary students.
- While it is recognized that some training will occur during the year of clinical experience, it is primarily a period of evaluation and is not considered a substitute for college-level instruction.
- The candidate is to work under professional supervision.
- The supervising veterinarian(s) is not expected to derive economic advantage from the activities of the candidate.
- The candidate is not, based on participation in the ECFVG program, entitled to employment at the end of the period of evaluated clinical experience.
- The candidate is not necessarily entitled to monetary compensation during the time of evaluated clinical experience.
- Participation in single species medicine, such as equine or feline, may provide up to three months of acceptable evaluated clinical experience.
An AVMA-accredited college of veterinary medicine (see Veterinary Colleges Accredited by the AVMA) wishing to provide an ECY for foreign-educated veterinary graduates should contact the ECFVG as soon as possible (preferably before allowing a foreign veterinary graduate to begin the program) for the purpose of documenting and obtaining approval of the college's proposed ECY program. The ECFVG will help the college develop a program that meets the requirements of Step 4 of the ECFVG certification program.
Application procedure—Each ECY site is responsible for enrolling ECFVG candidates into its ECY program. Eligible candidates interested in the ECY should contact one of the 12 ECFVG-approved ECY sites (Appendix 9). These sites include:
- Cornell University,
- University of Florida,
- Iowa State University,
- Kansas State University,
- Louisiana State University,
- Mississippi State University,
- University of Missouri,
- Oklahoma State University,
- Purdue University,
- University of Tennessee,
- Tufts University, and
- Tuskegee University.
Fees—The cost of the ECY varies, because each ECFVG-approved site determines its own fees.
Definition of clinical experience—The procedures listed on form ECFVG Form 4 (Appendix 10) are required. In the course of the prescribed year of clinical experience, the candidate should have opportunities to demonstrate professional competence in the following list of activities.
- Participate in individual cases in one or more of the following ways and, at various times, in each of the following ways:
- Diagnosis, including–
- Physical examination
- Obtaining laboratory specimens
- Conducting clinical pathological laboratory procedures
- Radiology
- Differential diagnosis
- Necropsy
- Medication, including–
- Administration of biologic and therapeutic agents by various routes
- Choice of agents to be used
- Determination of dosages
- Outlining suggested therapy
- Preventive medicine, including–
- Food hygiene
- Disease control
- Have contact with clients in one or more of the following ways and, at various times, in each of the following ways:
- Taking case histories
- Reviewing treatment
- Advising on patient management
- Estimating fees
- Handle administrative matters, including:
- Preparation of case records
- Preparation of health certificates
- Preparation of forms such as test reports and infectious disease reports.
- Preparation of orders for drugs and supplies, including restricted use drugs
Criteria of performance—
- The candidate will demonstrate competence in handling cases in all of the common species of both large and small animals. Experience in a single-species practice (for instance, equine exclusive or feline exclusive) may constitute no more than three months of the required year. The acceptable level of competence for candidates will be that normally expected of a new graduate of an AVMA accredited college of veterinary medicine (see Veterinary Colleges Accredited by the AVMA).
- The candidate will demonstrate competence in communicating with clients in the English language.
- The candidate will demonstrate competence to perform administrative duties to such a degree that the supervising veterinarian can in good conscience sign forms prepared by the candidate without corrections.
- The cases, clients, and administrative functions dealt with by the candidate will be a representative sample of the total caseload of the college's clinics.
Responsibilities of the candidate—
- The candidate will be prepared to provide his own living expenses during the year of clinical experience and will pay such fees as are required by the institution by which he/she is accepted.
- The candidate will be available for duty at such hours as the supervising veterinarian(s) may require, including a minimum of forty hours per week and a maximum of sixty hours per week, including night and holiday hours as served by regular staff members. There will be no requirement for remuneration to the candidate for work done during the specified time of evaluation.
- The candidate will act at all times under the direct supervision of the supervising veterinarian(s). The candidate will take no measures that could result in injury to the patient or the people involved or dissatisfaction of the owner of the patient except in the immediate presence of the supervising veterinarian(s).
- The candidate will keep a complete written record of all the veterinary activities in which he/she engages. This record will include diagnoses made and diagnostic measures used, drugs and dosages administered, names of surgical procedures done, and identification of administrative functions performed. This record will be for the use of the supervising veterinarian(s) in evaluating the candidate, and need not be submitted to ECFVG unless specifically requested.
Responsibilities of the supervising veterinarian—
- The veterinary college will supply all equipment, drugs, and supplies including special protective clothing required by the candidate in the performance of his/her clinical duties.
- The supervising veterinarian(s) will review the record kept by the candidate each week, and will report to ECFVG on the prescribed form at the end of his/her period of supervisory responsibility, such as a block, or not less than every three months, on the activities of the candidate and the level of competence demonstrated. If at the end of any three-month period it is the opinion of the supervising veterinarian(s) that the knowledge and skill of the candidate are totally inadequate, ECFVG may terminate the clinical experience. All such reports will be submitted, using ECFVG Form 4 (Appendix 10).
- The supervising veterinarian(s) will periodically consult in private with the candidate for the purpose of discussing any difficulties that may arise in the course of the candidate's work, and to inform the candidate of the quality of his/her work, in much the same manner these activities are conducted with senior students.
- The supervising veterinarian(s) will provide opportunities for the candidate to deal with patients, clients, and administrative matters in such numbers as to permit sound evaluation of the competence of the candidate. He/she will encourage the candidate to participate in all parts of the clinic function where students are normally involved.
- The supervising veterinarian(s) will in no case either direct or knowingly permit the candidate to perform any act that is in violation of local, state, or national law, particularly as it applies to the practice of veterinary medicine.
- The responsibilities of the supervising veterinarian(s) may be delegated by the college to any fully qualified veterinarian who is a regularly employed member of the faculty.
- The supervising veterinarian(s) shall be aware of the insurance ramifications of having an ECFVG candidate in the practice.
- In the case of damage to a patient caused by an act of a supervised candidate, the college would be covered by its professional liability insurance. The candidate, of course, would not be covered unless he/she purchased their coverage from a private source.
- In the case of injury to a candidate under the college's supervision, the college should have Professional Liability, Public Liability, and Workmen's Compensation insurance and probably an Umbrella Liability policy for the best protection of the supervising veterinarian or his/her college. Consultation with local insurance representatives or the AVMA Professional Liability Insurance Trust (PLIT) is advised.
Other types of clinical experience—An ECFVG candidate's postgraduate clinical experience acquired at an AVMA-accredited college (see Veterinary Colleges Accredited by the AVMA) prior to the ECFVG's approval of a college's ECY program or prior to a candidate's registration with the ECFVG may not count towards completion of Step 4 of the certification program. Such in- or out-of-sequence clinical experience will be evaluated by the ECFVG on a case-by-case basis, in accordance with established guidelines (ECFVG Form 7; Appendix 11), and all such clinical experience must be documented on appropriate evaluation forms (ECFVG Form 4; Appendix 10).
The ECFVG also considers approval of evaluated clinical experience completed during an internship or residency or at a non-ECFVG-approved site on a case-by-case basis in accordance with established guidelines (Appendix 11).
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V. Testing Accommodations | Top |
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Introduction—In accordance with the Americans with Disabilities Act and other applicable laws, the AVMA/ Educational Commission for Foreign Veterinary Graduates (ECFVG) provides equal access to programs and services for individuals with documented disabilities.
The Americans with Disabilities Act of 1990 (ADA) and accompanying regulations define a person with a disability as someone with a physical or mental impairment that substantially limits one or more major life activities such as walking, seeing, hearing, or learning. The purpose of documentation is to validate that the applicant is covered under the ADA. Comprehensive information by a qualified professional is necessary to allow the ECFVG to understand the nature and extent of the applicant's disability and the resulting functional impairment that limits access to its examinations. Documentation also allows the ECFVG to provide appropriate accommodations for such a disability.
Documentation submitted by an applicant in support of a request is reviewed by the ECFVG for consideration and may be forwarded to outside experts for impartial professional review.
The ECFVG Policy on Testing Accommodations provides individuals, schools, professional diagnosticians, and service providers with information regarding how to document a disability and a related need for accommodations for candidates for the ECFVG Clinical Proficiency Examination (CPE). The information and documentation submitted should be as comprehensive as possible in order to allow the ECFVG to make an informed decision on the accommodation request and to avoid time delays in the decision-making process.
The purpose of accommodations is to provide equal access to the CPE. Accommodations "match up" with the identified functional limitation so that the area of impairment is mitigated by an auxiliary aid or adjustment to the testing procedure. Functional limitation refers to the behavioral manifestations of the disability that impede the individual's ability to function; that is, what someone cannot do on a regular and continuing basis as a result of the disability. For example, a functional limitation might be an inability to hear within normal limits. An appropriate accommodation might be use of an amplified stethoscope. It is essential that the documentation submitted with an accommodations request provide a clear explanation of the functional impairment and a rationale for the requested accommodation.
As noted in the CPE Manual of Administration, the Clinical Proficiency Examination (CPE) is a hands-on examination of entry-level educational clinical skills and judgments designed for graduates of non-AVMA/Council on Education (COE)-accredited veterinary colleges. The CPE is intended to assess the practical clinical veterinary skills of an "entry-level" veterinarian (ie, a new graduate of an AVMA/COE-accredited school). The CPE Manual of Administration lists the specific clinical proficiency skills measured by each section of the examination.
The ECFVG will provide reasonable accommodations designed to facilitate equal access to the CPE. Accommodations will be considered on a section-by-section basis. Because of the different clinical skills measured by the different sections, accommodations may be provided for some sections but not for others. In no case will accommodations be provided that would compromise any examination section's ability to test accurately the skills and knowledge it purports to measure. Similarly, no auxiliary aid or service will be provided that will fundamentally alter any section of the examination.
As part of the measurement of clinical "efficiency," candidates are assessed on their timely and effective use of resources to complete a procedure. Efficiency is a component of competency. Therefore, an accommodation of additional testing time will not be provided for those sections that assess efficiency. Similarly, no accommodations, including additional testing time, will be provided where the safety and welfare of an animal may be compromised.
While the use of accommodations in the test activity may enable the individual to better demonstrate his or her mastery of clinical skills, accommodations are not a guarantee of improved performance, test completion, or a passing score.
When to Request Test Accommodations for the CPE—Once the ECFVG office notifies a candidate who requires accommodations that he or she is eligible for the CPE, the candidate should request an ECFVG Test Accommodation Request Form for the Clinical Proficiency Examination (CPE) from the ECFVG office at the same time he or she requests a CPE application. The completed ECFVG Test Accommodation Request Form must be submitted to the ECFVG office at the same time as the completed CPE application. Appropriate documentation of the disabling condition and need for accommodations must accompany the ECFVG Test Accommodation Request Form. In order to facilitate processing, the ECFVG encourages applicants to provide detailed and complete responses to the request for test accommodations and accompanying documentation.
How to Request Test Accommodations for the CPE—If a candidate has a documented disability covered under the Americans with Disabilities Act (ADA) and requires test accommodations, he/she must notify the ECFVG in writing each time he/she applies for an accommodation. The individual requesting accommodations must personally initiate a written request for test accommodations. Accommodation requests by a third party (such as an evaluator or veterinary school) cannot be honored. Candidates should read and comply with the following seven steps to request accommodations:
- Read the General Guidelines for Documenting Disabilities, Guidelines for Documenting Learning Disabilities, and Guidelines for Documenting Attention-deficit/Hyperactivity Disorder and share them with the professional who will be preparing your documentation. Your treating professional must provide the necessary supporting documentation as described in these guidelines.
- Complete and sign the ECFVG Test Accommodation Request Form for the Clinical Proficiency Examination (CPE), which may be obtained by requesting a form in writing from the ECFVG office at the time you request a CPE application. Alternatively, if you are applying to retake one, two, or three failed sections of the CPE, complete and sign the ECFVG Request for Subsequent (Retake) Test Accommodations for the Clinical Proficiency Examination (CPE), which may also be obtained on written request from the ECFVG office.
- Attach documentation of the disability and your need for accommodation.
- Compare your documentation with the information listed in the General Guidelines for Documenting Disabilities, Guidelines for Documenting Learning Disabilities, and Guidelines for Documenting Attention-deficit/Hyperactivity Disorder to ensure a complete submission.
- Incomplete documentation will delay processing of your request.
- Attach a personal statement describing your disability and its impact on your ability to function in a clinical setting and in your daily life. If you are currently a practicing veterinarian, also describe any current workplace accommodations.
- Submit all documentation as outlined in the General Guidelines for Documenting Disabilities, Guidelines for Documenting Learning Disabilities, and Guidelines for Documenting Attention-deficit/Hyperactivity Disorder, including the following:
- Typed or printed letters and reports from evaluators on official letterhead.
- All documents in English. You are responsible for providing certified English translations of foreign-language documentation.
- Records from childhood if you are requesting accommodations based on a developmental disorder such as learning disorders (LD) or attention deficit/hyperactivity disorder (ADHD).
- Documentation of your functional impairment in activities beyond test-taking.
- Verification of your functional impairment by impartial third-party individuals who have observed you in day-to-day functioning or in clinical situations.
- Retain a photocopy of all Request Forms and documentation submitted.
- Send your completed ECFVG Test Accommodation Request Form for the CPE and documentation via a traceable or return-receipt method with your CPE application to:
AVMA/ECFVG
Attn: Testing Coordinator
1931 N. Meacham Rd. Suite 100
Schaumburg, IL 60173
General Guidelines for Documenting Disabilities—The following guidelines are provided to assist the applicant in documenting a need for accommodation based on an impairment that substantially limits one or more major life activities. To support a request for test accommodations, a candidate must please submit the following documentation from his/her testing professional:
- A detailed, comprehensive written report describing the candidate's disability and its severity and justifying the need for the requested accommodations. Documentation in support of requests for accommodations on the basis of a learning disability or attention-deficit/hyperactivity disorder must also comply with the Guidelines for Documenting Learning Disabilities or Guidelines for Documenting Attention-Deficit/Hyperactivity Disorder, respectively.
- The following characteristics are expected of all documentation submitted in support of a request for accommodations. Documentation must:
- State a specific diagnosis of the disability. A professionally recognized diagnosis for the particular category of disability is expected (eg, the DSM-IV diagnostic categories for learning disabilities).
- Be current. Because the provision of reasonable accommodations is based on assessment of the current impact of the examinee's disability on the testing activity, it is in the individual's best interest to provide recent documentation. As the manifestations of a disability may vary over time and in different settings, in most cases an evaluation should have been conducted within the past three years. For example, low vision or neuromuscular conditions are often subject to change and should be updated for current functioning.
- Describe the specific diagnostic criteria and name the diagnostic tests used, including date(s) of evaluation, specific test results, and a detailed interpretation of the test results. This description should include the results of diagnostic procedures and tests utilized and should include relevant educational, developmental, and medical history. Specific test results should be reported to support the diagnosis. For example, documentation for an examinee with multiple sclerosis should include specific findings on the neurological examination including functional limitations and MRI or other studies, if relevant. Diagnostic methods used should be appropriate to the disability and current professional practices within the field. Informal or non-standardized evaluations should be described in enough detail that other professionals could understand their role and significance in the diagnostic process.
- Describe in detail the individual's limitations due to the diagnosed disability (ie, a demonstrated impact on functioning on the CPE) and explain the relationship of the test results to the identified limitations resulting from the disability. The current functional impact on physical, perceptual, and cognitive abilities should be fully described (eg, the extent to which an examinee with macular degeneration and resulting reduced central vision is limited in the ability to read).
- Recommend specific accommodations and/or assistive devices including a detailed explanation of why these accommodations or devices are needed and how they will reduce the impact of the identified functional limitations. Accommodation requests for the CPE and their justification must be section specific. For example, a request for special lighting might be appropriate for the Surgery section, but not for the Small Animal Practice section. Extra time might be appropriate for the written stations in such sections as Small Animal Practice and Radiology but not for sections requiring demonstration of competencies required in Anesthesia or Surgery.
- Establish the professional credentials of the evaluator that qualify him or her to make the particular diagnosis, including information about licensure or certification and specialization in the area of the diagnosis. The evaluator should present evidence of comprehensive training and direct experience in the diagnosis and treatment of adults in the specific area of disability.
- If no prior accommodations have been provided, the qualified professional expert should include a detailed explanation as to why no accommodations were given in the past and why accommodations are needed now.
Guidelines for Documenting Learning Disabilities—The following information is provided to clarify the documentation process for applicants submitting a request for accommodations based specifically on a learning disability or cognitive impairment.
- The evaluation must be conducted by a qualified professional. The qualified professional (diagnostician) must have comprehensive training in the field of learning disabilities and must have comprehensive training and direct experience in working with an adult population.
- Testing/assessment must be current. The determination of whether an individual is significantly limited in functioning according to ADA criteria is based on assessment of the current impact of the impairment. (See General Guidelines for Documenting Disabilities). A developmental disorder such as a learning disability originates in childhood and, therefore, information which demonstrates a history of impaired functioning should also be provided.
- Documentation must be comprehensive. Objective evidence of a substantial limitation in cognition or learning must be provided. At a minimum, the comprehensive evaluation should include the following:
- A diagnostic interview and history taking. Because learning disabilities are commonly manifested during childhood, though not always formally diagnosed, relevant historical information regarding the individual's academic history and learning processes in elementary, secondary and postsecondary education should be investigated and documented. The report of assessment should include a summary of a comprehensive diagnostic interview that includes relevant background information to support the diagnosis. In addition to the candidate's self-report, the report of assessment should include:
- A description of the presenting problem(s);
- A developmental history;
- Relevant academic history including results of prior standardized testing, reports of classroom performance and behaviors including transcripts, study habits and attitudes and notable trends in academic performance;
- Relevant family history, including primary language of the home and current level of fluency in English;
- Relevant psychosocial history;
- Relevant medical history including the absence of a medical basis for the present symptoms;
- Relevant employment history;
- A discussion of dual diagnosis, alternative or co-existing mood, behavioral, neurological and/or personality disorders along with any history of relevant medication and current use that may impact the individual's learning; and
- Exploration of possible alternatives that may mimic a learning disability when, in fact, one is not present.
- A psychoeducational or neuropsychological evaluation. The psychoeducational or neuropsychological evaluation must be submitted on the letterhead of a qualified professional, and it must provide clear and specific evidence that a learning or cognitive disability does or does not exist. It must also have the following characteristics:
- The assessment must consist of a comprehensive battery of tests.
- A diagnosis must be based on the aggregate of test results, history and level of current functioning. It is not acceptable to base a diagnosis on only one or two subtests.
- Objective evidence of a substantial limitation to learning must be presented.
- Tests must be appropriately normed for the age of the patient and must be administered in the designated standardized manner.
- Minimally, the domains to be addressed in the psychoeducational or neuropsychological evaluation should include assessment of:
- Cognitive Functioning: A complete cognitive assessment is essential with all subtests and standard scores reported. Acceptable measures include but are not limited to: Wechsler Adult Intelligence Scale-III (WAIS-III); Woodcock Johnson Psychoeducational Battery-III (WJ-III): Tests of Cognitive Ability; Kaufman Adolescent and Adult Intelligence Test.
- Achievement: A comprehensive achievement battery with all subtests and standard scores is essential. The battery must include current levels of academic functioning in relevant areas such as reading (decoding and comprehension) and mathematics. Acceptable instruments include, but are not limited to, the Woodcock-Johnson Psychoeducational Battery - Revised: Tests of Achievement (WJ-III); The Scholastic Abilities Test for Adults (SATA); Woodcock Reading Mastery Tests-III. Specific achievement tests are useful instruments when administered under standardized conditions and when interpreted within the context of other diagnostic information. The Wide Range Achievement Test-3 (WRAT-3) and the Nelson-Denny Reading Test are not comprehensive diagnostic measures of achievement and therefore neither is acceptable if used as the sole measure of achievement.
- Information Processing: Specific areas of information processing (e.g., short- and long-term memory, sequential memory, auditory and visual perception/processing, auditory and phonological awareness, processing speed, executive functioning, motor ability) must be assessed. Acceptable measures include, but are not limited to, the Detroit Tests of Learning Aptitude - Adult (DTLA-A), Wechsler Memory Scale-III (WMS-III), information from the Woodcock Johnson Psychoeducational Battery-III Tests of Cognitive Ability, as well as other relevant instruments that may be used to address these areas.
- Other Assessment Measures: Other formal assessment measures or nonstandard measures and informal assessment procedures or observations may be integrated with the above instruments to help support a differential diagnosis or to disentangle the learning disability from co-existing neurological and/or psychiatric issues. In addition to standardized test batteries, nonstandardized measures and informal assessment procedures may be helpful in determining performance across a variety of domains.
- Actual test scores must be provided (age-based standard scores where available) as well as identification of norms used to interpret the data. Evaluators should use the most recent form of tests and should identify the specific test form as well as the norms used to compute scores. It is helpful to list all test data in a score summary sheet appended to the evaluation.
- Records of academic history should be provided. Because learning disabilities are most commonly manifested during childhood, relevant records detailing learning processes and difficulties in elementary, secondary and postsecondary education should be included. Such records as grade reports, transcripts, teachers' comments and the like will serve to substantiate self-reported academic difficulties in the past and present.
- A differential diagnosis must be reviewed and various possible alternative causes for the identified problems in academic achievement should be ruled out. The evaluation should address key constructs underlying the concept of learning disabilities and provide clear and specific evidence of the information processing deficit(s) and how these deficits currently impair the individual's ability to learn. No single test or subtest is a sufficient basis for a diagnosis. The differential diagnosis must demonstrate that:
- Significant difficulties persist in the acquisition and use of listening, speaking, reading, writing or reasoning skills.
- The problems being experienced are not primarily due to lack of exposure to the behaviors needed for academic learning or to an inadequate match between the individual's ability and the instructional demands.
- A clinical summary must be provided. A well-written diagnostic summary based on a comprehensive evaluative process is a necessary component of the report. Assessment instruments and the data they provide do not diagnose; rather, they provide important data that must be integrated with background information, historical information and current functioning. It is essential then that the evaluator integrates all information gathered in a well-developed clinical summary. The following elements must be included in the clinical summary:
- Demonstration of the evaluators having ruled out alternative explanations for the identified academic problems as a result of poor education, poor motivation and/or study skills, emotional problems, attentional problems and cultural or language differences;
- Indication of how patterns in cognitive ability, achievement and information processing are used to determine the presence of a learning disability;
- Indication of the substantial limitation to learning presented by the learning disability and the degree to which it impacts the individual in the context of the CPE; and
- Indication as to why specific accommodations are needed and how the effects of the specific disability are mediated by the recommended accommodation(s).
- Each accommodation recommended by the evaluator must include a rationale.
The evaluator must describe the impact the diagnosed learning disability has on a specific major life activity as well as the degree of significance of this impact on the individual. The diagnostic report must include specific recommendations for accommodations and a detailed explanation as to why each accommodation is recommended. Recommendations must be tied to specific diagnostic test results or clinical observations. The documentation should include any record of prior accommodation or auxiliary aids, including any information about specific conditions under which the accommodations were used and whether or not they were effective. However, a prior history of accommodation, without demonstration of a current need, does not in and of itself warrant the provision of a like accommodation. If no prior accommodation(s) has been provided, the qualified professional expert should include a detailed explanation as to why no accommodation(s) was used in the past and why accommodation(s) is needed at this time.
- Problems such as test anxiety, English as a second language in and of itself, slow reading without an identified underlying cognitive deficit or failure to achieve a desired academic outcome are not learning disabilities and, therefore, are not covered under the ADA.
Guidelines for Documenting Attention-Deficit/Hyperactivity Disorder (ADHD)—For those applicants submitting a request for accommodations based specifically on Attention-Deficit/Hyperactivity Disorder (ADHD), the following additional information is provided to clarify the documentation process:
- The evaluation must be conducted by a qualified diagnostician. Professionals conducting assessments and rendering diagnoses of ADHD must be qualified to do so. Comprehensive training in the differential diagnosis of ADHD and other psychiatric disorders and direct experience in diagnosis and treatment of adults is necessary. The evaluator's name, title and professional credentials, including information about license or certification as well as the area of specialization, employment and state in which the individual practices should be clearly stated in the documentation.
- Testing/assessment must be current. The determination of whether an individual is "significantly limited" in functioning is based on assessment of the current impact of the impairment on the CPE (see General Guidelines for Documenting Disabilities).
- Documentation necessary to substantiate the ADHD must be comprehensive. Because ADHD is, by definition, first exhibited in childhood (although it may not have been formally diagnosed) and in more than one setting, objective, relevant, historical information is essential. Information verifying a chronic course of ADHD symptoms from childhood through adolescence to adulthood, such as educational transcripts, report cards, teacher comments, tutoring evaluations, job assessments, and the like are necessary.
- The evaluator is expected to review and discuss DSM-IV diagnostic criteria for ADHD and describe the extent to which the patient meets these criteria. The report must include information about the specific symptoms exhibited and document that the patient meets criteria for long-standing history, impairment, and pervasiveness.
- A history of the individual's presenting symptoms must be provided, including evidence of ongoing impulsive/hyperactive or inattentive behaviors (as specified in DSM-IV) that significantly impair functioning in two or more settings.
- The information collected by the evaluator must consist of more than a self-report. Information from third party sources is critical in the diagnosis of adult ADHD. Information gathered in the diagnostic interview and reported in the evaluation should include, but not necessarily be limited to, the following:
- History of presenting attentional symptoms, including evidence of ongoing impulsive/hyperactive or inattentive behavior that has significantly impaired functioning over time;
- Developmental history;
- Family history for presence of ADHD and other educational, learning, physical, or psychological difficulties deemed relevant by the examiner;
- Relevant medical and medication history, including the absence of a medical basis for the symptoms being evaluated;
- Relevant psychosocial history and any relevant interventions;
- A thorough academic history of elementary, secondary, and postsecondary education;
- Review of psychoeducational test reports to determine if a pattern of strengths or weaknesses is supportive of attention or learning problems;
- Evidence of impairment in several life settings (home, school, work, etc) and evidence that the disorder significantly restricts one or more major life activities.
- Relevant employment history;
- Description of current functional limitations relative to a clinical practice setting and to the CPE in particular that are presumably a direct result of the described problems with attention;
- A discussion of the differential diagnosis, including alternative or co-existing mood, behavioral, neurological, or personality disorders that may confound the diagnosis of ADHD; and
- Exploration of possible alternative diagnoses that may mimic ADHD.
- Relevant assessment batteries must be described. A neuropsychological or psychoeducational assessment may be necessary in order to determine the individual's pattern of strengths or weaknesses and to determine whether there are patterns supportive of attention problems. Test scores or subtest scores alone should not be used as the sole basis for the diagnostic decision. Scores from subtests on the Wechsler Adult Intelligence Scale - III (WAIS - III), measures of memory function, or attention or tracking tests or continuous performance tests do not in and of themselves establish the presence or absence of ADHD. They may, however, be useful as one part of the process in developing clinical hypotheses. Checklists or surveys can serve to supplement the diagnostic profile but by themselves are not adequate for the diagnosis of ADHD. When testing is used, age-based standard scores must be provided for all normed measures.
- Identification of DSM-IV criteria. A diagnostic report must include a review of the DSM-IV criteria for ADHD both currently and retrospectively and specify which symptoms are present (see DSM-IV for specific criteria). According to DSM-IV, "the essential feature of ADHD is a persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequent and severe than is typically observed in individuals at a comparable level of development." Other criteria include:
- Symptoms of hyperactivity-impulsivity or inattention that cause impairment that were present in childhood.
- Current symptoms that have been present for at least the past six months.
- Impairment from the symptoms present in two or more settings (school, work, home, etc).
- Documentation must include a specific diagnosis. The report must include a specific diagnosis of ADHD based on the DSM-IV diagnostic criteria. Individuals who report problems with organization, test anxiety, memory, and concentration only on a situational basis do not fit the prescribed diagnostic criteria for ADHD. Given that many individuals benefit from prescribed medications and therapies, a positive
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