A member of the working group assigned to explore the establishment of an independent educational equivalence program for graduates of nonaccredited veterinary colleges summed up the reaction he and his colleagues feel about the recent closure of talks: "a big disappointment."
Since early 2003, the six-member working group—three from the AVMA Educational Commission for Foreign Veterinary Graduates and three from the American Association of Veterinary State Boards' Program for the Assessment of Veterinary Education Equivalence Board—devoted themselves to the endeavor, co-chaired by Drs. Donald Draper of ECFVG and Susan Chadima, chair of the PAVE Board.
Dr. Deborah Kochevar of the ECFVG said, "(We) spent quite a lot of time looking at alternatives, having a public forum in Philadelphia (in June 2003) to gather input from any interested stakeholders in our profession, and the overwhelming conclusion to all of that fact-finding was that there was a lot of support for a truly independent, international student certification process."
They hoped there would be consensus on the need for an independent group with balanced representation, she said—but that didn't happen.
At a July 15 meeting in Kansas City, AVMA Executive Board and AAVSB Executive Committee representatives were unable to agree on the composition of an independent program.
Within days, each of the three PAVE Board representatives on the working group resigned from the PAVE Board. Dr. Chadima cited personal reasons when interviewed by JAVMA. Dr. Krehbiel felt the interests of the PAVE Board and his other commitments were best served by his resignation. Dr. Ralph Richardson said he has brought a lot of positive ideas to the table but felt it appropriate to turn his energies elsewhere and encourage others to be involved now.
Dr. Janver Krehbiel of the PAVE Board was discouraged that there was no discussion at the Kansas City meeting focused on resolving the dual pathway that exists.
Referring to the sticking point of defining an "independent" body, Dr. Draper said, "There clearly are different views, and each organization is entitled to their interpretation. I guess I was disappointed with the interpretation that AAVSB had, but that's their right."
Leading up to the July 15 meeting, Dr. Draper thought there was reason for optimism, partly because of comments by people from both organizations. "Based on the analysis that the six representatives performed, we believed it was possible for such an entity to exist."
Dr. Wallace Baze of the ECFVG said there were moments at the meeting when he thought an agreement might be reached. "I thought that the AVMA presented a reasonable solution to the problem. It wasn't just an AVMA solution—it was a solution that our group had come up with after having our stakeholders meeting in Philadelphia and going through all that process.
"From what I could tell, the AVMA did buy into that independent organization (concept), but the AAVSB chose not to."
Dr. Kochevar said that "independent," to the working group, meant it would not have a majority vote from either AVMA or AAVSB. It would be modeled after the Educational Commission for Foreign Medical Graduates.
"So, the first disappointment was that the definition that was held by AAVSB was that an independent body could only function appropriately if it had a majority vote from regulatory bodies, that is, state boards. ... it led to the ultimate inability to agree on any kind of next step," Dr. Kochevar noted.
Nevertheless, the meeting was not acrimonious, but one where Dr. Kochevar said everyone was professional, respectful, and courteous. "It was very telling that there was as much disappointment on the PAVE side as there was on the AVMA side."
Working group members cited reasons that a single licensing body is best. Dr. Chadima said, "My personal belief is that the profession and the licensing boards are best served by a single program, because there is too much division of limited resources for a small profession to have multiple programs." To a degree, she believes that lack of communication and political considerations are still influencing the ability to move forward.
"Having multiple pathways reduces the overall quality of potential candidates," Dr. Chadima added. "When candidates have the option to choose the pathway that they think will be best or easiest for them, it affects the overall quality of the candidate that is produced."
To have two licensure pathways is confusing to the candidates, Dr. Krehbiel said. "It's also confusing to foreign veterinarians in terms of what our process for licensure is. That's a concern, because foreign veterinarians and foreign veterinary schools look to the U.S. as having the gold standard for veterinary education for sophistication of the profession."
Despite the stalemate, some see good coming from the discussions. "The PAVE program has really, in spite of all of the controversy between AAVSB and AVMA, and ECFVG and PAVE, taken some important steps forward in terms of looking at new ways to evaluate educational equivalence," Dr. Chadima said.
In her opinion, introduction of the qualifying examination in the PAVE program as a screening tool is a potential model for a single program, and licensing examinations such as the North American Veterinary Licensing Examination should not be administered as screening tests.
The three ECFVG members concur with the AVMA House of Delegates' July 24 resolution (#7) directing the AVMA to "continue unabated and with deliberate haste its efforts to improve the certification process." They say this process has been ongoing.
"That's exactly what AVMA's intent is," Dr. Kochevar said, "to say we stand ready to consider an independent commission, but that right now, there's no way to get to that, based on the events in Kansas City. The only alternative is to take all the energy and resources we have and put them into making ECFVG as good as we can."
She believes the Association is 100 percent dedicated to addressing concerns that have been criticized. These include developing a high-volume examination site to resolve the backlog for the Clinical Proficiency Examination, replacing the NAVLE, and requiring that ECFVG candidates finish the required steps in sequence.
Drs. Kochevar and Draper are serving their last year on the ECFVG. Dr. Draper said the HOD resolution is a good one and reaffirms the continuous improvement process that has led to implementing quality assurance programs.
During his six-year term on the ECFVG, which ended in July, Dr. Baze agreed that especially in light of the competing systems, the commission has intensified its efforts to make sure the program is the best possible.
Optimism generally prevails among working group members that eventually, a single pathway may come to be.
"I am hopeful for the long term," Dr. Chadima said. "The professional association needs to understand the legitimate concerns on the part of the regulatory boards, and the regulatory boards need to appreciate the wider community in terms of the professional associations and the educational institutions that all need to be involved in working together in creating the ideal program."
The AAVSB has deeply held, firm convictions, she said, about the appropriateness of a profession regulating itself.
Dr. Draper was circumspect. "I suppose it's possible it could come about sometime in the future, but I don't see it in the near future. It appears as though each of the major parties that are involved want to pursue their own pathways and that they have their reasons for doing so, and that's just the way it is."
Although disappointed the initiative is not moving forward as rapidly as he would wish, Dr. Richardson said, "Certainly, I am still very optimistic that we will eventually reach one pathway of certification of qualifications for foreign veterinary graduates."
Dr. Richardson, who is dean of the Kansas State University College of Veterinary Medicine, said that data from the Association of American Veterinary Medical Colleges project a potential shortage of veterinarians as the U.S. population continues to increase.
"The need for graduate veterinarians, domestic as well as foreign veterinary graduates, will just simply increase, and the more quickly we resolve and expedite the solutions of how we deal with foreign graduates and nonaccredited, offshore schools, the better our profession will be."