March 15, 2015

 

 Past council decisions a continued source of debate

​COE supporters say not all criticisms are evidence-based

Posted Feb. 25, 2015

Depending on whom you ask, the AVMA Council on Education does a good job of ensuring that veterinary colleges produce competent entry-level practitioners­­—or is rife with political influence and inconsistently enforces vague standards.

So how can an accrediting body elicit such polarized views?

Much of the criticism the COE has encountered has to do with historical events rather than current ones, said Dr. John R. Pascoe, a COE member and former chair as well as executive associate dean at the University of California-Davis School of Veterinary Medicine.

For example, the COE continues to come under fire for accrediting in 2001 the Western University of Health Sciences in Pomona, California, which features a distributive teaching model that has off-site clinical training as opposed to a traditional veterinary teaching hospital. Since then, one more veterinary college has been accredited that uses the same model. Two new programs with distributive clinical teaching models received provisional accreditation this past year.

An argument that often comes up about this model is that the COE has no way of ensuring that quality education is given at all the sites used by the veterinary colleges.

Dr. Pascoe says the council has developed a rubric to evaluate off-campus clinical sites that is publicly available in the Accreditation Policies and Procedures of the COE and that site teams visit all of a college’s core clinical sites, which constitute a virtual teaching hospital.

“The decision process was made many councils ago; no current member participated in any of that, but if you track the history of that in (the Accreditation Policies and Procedures) manual, you can see the evolving thought process. There are people who clearly hold opinions that don’t agree with the distributive model, but if you look at other professions, particularly the clinical training of medical students, that is how it is primarily done, through the distributive model,” Dr. Pascoe said. “I feel pretty comfortable that the council, in general, has a process in place to fairly and reasonably evaluate the quality of those sites and the education students get.”

Dr. Trevor R. Ames, president of the Association of American Veterinary Medical Colleges and dean of the University of Minnesota College of Veterinary Medicine, concurred, saying that critics have no evidence that the current graduates of colleges with newer education models are any differently trained than those coming out of traditional models.

“In fact, we have employers including Banfield—the largest employer of vets in the nation—stating at the (U.S. Department of Education’s National Advisory Committee on Institutional Quality and Integrity) hearing that graduates are the same. Similarly, we are not seeing problems with licensing boards dealing with complaints associated with graduates associated with a certain education model. ... Those are important pieces of evidence that have to be looked at when we’re understanding the function of the COE and how it has applied standards,” Dr. Ames said.

It’s confidential

Another historical issue that has raised critics’ ire has been the dismissal of two members—Drs. William Kay in 2007 and Mary Beth Leininger in 2014—and, relatedly, the perceived lack of transparency by the council.

Neither Dr. Pascoe nor Dr. Karen Martens Brandt, director of the AVMA Education and Research Division, would comment on either case but said only that Dr. Leininger’s dismissal was still under appeal.

She was removed from the COE apparently after making comments during a reference committee meeting at the 2014 AVMA House of Delegates regular winter session. At the time, the HOD was deliberating on whether to support having the COE continue to accredit veterinary colleges outside the U.S. and Canada. Dr. Leininger expressed support for the resolution that the COE should not consider those schools for accreditation. She questioned whether the COE had the resources to do so and also how the COE evaluates schools with the distributive model of education.

At one point, she said, “This is me, and I’m probably the only one on the council who feels this way, but there’s a big issue with consistency. We don’t expect every school to be rubber-stamped, but how we evaluate becomes awkward” in reference to veterinary colleges outside the U.S. and Canada.

When she joined the council, Dr. Leininger had to sign a confidentiality agreement as well as a code of conduct, which requires COE members to speak as one voice through the chair of the council.

Dr. Sheila W. Allen, former COE chair and current dean of the University of Georgia College of Veterinary Medicine, said the council always had a confidentiality agreement, and members signed a code of conduct to abide by the rules. While Dr. Allen served on the COE, the code was revised to establish potential consequences for not abiding by it.

She explained, “Council members who work in other volunteer organizations that have some sort of code of conduct felt as though ours wasn’t as clear as it should be. I think it’s important to note that the council encourages all members to speak freely on all accreditation matters during council meetings. There’s no obstacle to speaking your mind during council deliberations; however, outside of council deliberations, the COE felt it’s important the council speak with one voice through the chair, and that members who don’t share the majority view not speak against it publicly.

“It’s vitally important that all institutions evaluated for accreditation have confidence that the council is an unbiased, fair body that is deliberating on that decision. Having a council member speak out against a specific institution or certain method of going about meeting a standard, it obviously leads the public to believe that member and perhaps others are biased against some institutions and not others.”

The “greater good”

Another comment that often came up during the NACIQI hearing this past December and the COE listening session Jan. 18 during the North American Veterinary Community Conference in Orlando, Florida (see story) was that the leadership of the AVMA controls what the COE does and doesn’t do.

Dr. Ames says a big misconception is that the basic structure of an accrediting body has substantial influence on the accreditation process, or that accrediting bodies embedded in a professional society behave differently than accrediting bodies established as separate entities.

The accrediting bodies for colleges of dentistry, optometry, and osteopathic medicine, for example, are embedded in professional societies. The accrediting bodies for colleges of public health and allopathic medicine are co-sponsored by their respective professions’ equivalents of the AVMA and AAVMC.

“Accrediting bodies are basically applying standards in a uniform way. The goal is to ensure colleges are producing entry-level professionals. If that is the goal, then you’re not necessarily going to prohibit one type of educational model” or stop new institutions from forming just by removing the COE from AVMA, Dr. Ames said.

Dr. Pascoe adds that a potential consequence of the COE being separate is that it would substantially increase the cost of accreditation because doing so would require new office space, staff, counsel, liability insurance, and the like.

Dr. Martens Brandt, the COE staff liaison, says the AVMA houses the COE because it’s one of the “greater good” activities the Association does for the profession.

“It’s how we support the future of our profession. And we’ve been looking at schools for many, many years. Since 1906, the COE has been accrediting schools, and there’s been a form of an (AVMA) education standard since 1921. There’s a lot of history,” she said. “Just like advocacy, accreditation is important to members. The council is in a continual process of improvement and is looking to make its processes better. That takes time.”

Dr. Martens Brandt is referring to a survey the Association sent to 16,000 members, all AVMA volunteers, and 5,000 veterinary students. Respondents rated the importance of various AVMA activities and scored how well they thought the Association was doing at each activity. Accreditation was rated highly—the second highest of 11 services in importance and the fifth highest of 11 in performance (see JAVMA, March 1, 2015).

As it turns out, the AVMA’s new strategic plan, which lists “protect and enhance the lifelong value of the veterinary degree” as a primary objective, could result in the COE receiving even greater resources. Dr. Martens Brandt said staffing is under review, with the potential to increase in the near future.

Dr. Allen said when she was on the council, she had advocated for greater staff support. For example, Dr. David E. Granstrom, former COE staff liaison and current AVMA chief operating officer, would go on all the site visits, which was an undue burden on him, she said. 

In addition, the COE now has 35 site visitors in place to conduct site visits at veterinary schools on its behalf, freeing up the council members’ time by their not having to travel as often.

Greater transparency

What will happen with the COE’s future and how changes will be perceived by members will require better communication and responsiveness on the part of the council.

Dr. Martens Brandt says the council wants to hear concerns from practitioners but also urges patience and understanding on their part.

“The council has made a lot of changes in the last few years. You have to give them time to fully implement everything and work through those (new) processes and how they do, and see how it goes. Give them a chance to come into fulfillment, really,” Dr. Martens Brandt said. “We need to give time for the process to mature and develop.”

Dr. Sharon Hurley, Minnesota alternate delegate, agreed, saying during an AVMA House of Delegates reference committee meeting on Jan. 9, “We tend to get hung up on things from the past, but things have changed, and sometimes things brought up as criticisms of the COE have been changed. They’re not there anymore, and we need to stop hanging onto them.”

She continued, “Part of that transparency we ask for is our responsibility to look for. ... Sometimes communications get a little muddled, and it’s like how the telephone game can change things from beginning to end. We hear one thing and interpret something else. We need to continue to take personal responsibility for finding out information (we want from the COE) so we can get back into a feeling of trust.”  

Related JAVMA content:

HOD again rejects measures to stop foreign accreditation (March 1, 2014)

Report finds benefits to foreign accreditation (June 15, 2013)