Directional change possible for foreign graduate certification

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At the center of the current debate over who should administer the US certification program for foreign-trained veterinary graduates is a philosophic question: is it a function of ensuring that their educational competence is comparable to that of graduates from AVMA-accredited schools, as the AVMA believes, or part of the licensure process, as the American Association of Veterinary State Boards maintains?

The Educational Commission for Foreign Veterinary Graduates program has been in place since 1964. The ECFVG program assesses the competence of foreign-trained veterinarians to ensure that their knowledge and skills are equal to those of graduates from AVMA-accredited or -approved veterinary colleges. An independent commission, the ECFVG is advisory to the AVMA Council on Education.

All but two states currently require an ECFVG certificate before licensing a foreign-trained veterinarian.

The AAVSB is interested in convincing state boards to invest that responsibility in the AAVSB rather than with the ECFVG. Recent indications are that the National Board Examination Committee would support that move.

At its delegate assembly July 24 in Salt Lake City, the AAVSB resumed discussion of the topic. A straw poll showed that 25 of the 37 AAVSB member boards present would support the AAVSB developing a certification program. There are 56 jurisdictions within the AAVSB: the 50 states, District of Columbia, Puerto Rico, Virgin Islands, and three Canadian provinces.

Dr. James R. Corley, then AAVSB president-elect, and Dr. Nancy Collins, incoming chair of the NBEC, outlined the AAVSB's proposed educational equivalency program. It calls for credential verification (proof of graduation) and English proficiency, just as the ECFVG program does. In place of a passing score on the North American Veterinary Licensing Examination required by the ECFVG, the AAVSB proposes a preclinical science examination.

Once candidates completed those requirements, the AAVSB would require a clinical skills examination or one year in a clinical program at an AVMA-accredited veterinary college. Currently the ECFVG requires the Clinical Proficiency Examination or a year of evaluated clinical experience at an AVMA-accredited or -approved college. Unlike the ECFVG clinical year, the AAVSB year could be the fourth year of the curriculum and is not an evaluated year. The ECFVG has recently proposed working toward using the CPE alone as the fourth step, because it can be standardized and is defensible.

Dr. Collins said that the success of the AAVSB program would be measured by keeping the fee the same or less, validating the examination, and shortening the waiting period.

In reality, however, there is only a short waiting period for the Clinical Proficiency Examination, because of actions taken by the AVMA Executive Board in April 1998. As of May 2000, 970 candidates were enrolled in the ECFVG program. Only 58 qualified applicants have fulfilled the first three steps and requested an examination slot, and 70 percent of them will sit for the examination before the end of 2000, with the remaining ones scheduled early in 2001.

Counsel for the AAVSB spoke at the meeting, saying it is a conflict of interest for the AVMA to be involved in the certification of foreign-trained graduates because the AAVSB sees this as part of the licensure rather than the accreditation process. Dr. Corley said another AVMA conflict relates to restriction of entry into the profession.

Responding to a question about the AVMA's reason for wanting to retain the ECFVG program, newly elected AVMA Executive Board chairman, Dr. Jan E. Bartels, who attended as an observer, said, "The AVMA is a professional association, but the accreditation/certification process falls under US Department of Education purview, and [these functions are held separate] to prevent conflicts of interest."

Dr. Bartels said it is the AVMA's hope to transfer the Clinical Proficiency Examination — the fourth step in the ECFVG program — to the NBEC. The AVMA would like to see the NBEC submit a proposal to administer the CPE, in response to the AVMA's recently issued request for proposals. "The AVMA would like to relinquish it to NBEC for quality, reliability, task analysis, etc."

He noted that the AAVSB and NBEC have been invited to the ECFVG meeting Oct 3-4, and that on July 22, the AVMA Executive Board took another step toward keeping open the dialogue begun in June, when "issues were put on the table in a candid but civil and upbeat [manner]." To keep talks open, the board has approved another meeting between the AAVSB, NBEC, and AVMA.

Dr. Corley said, "We will continue on a path outlined today and redouble our efforts with the AVMA to see what common ground we have."

The model practice act is another area where there may now be duplication of effort. The AVMA publishes its Model Veterinary Practice Act in the AVMA Directory and is in the process of updating it. On July 23, a year after initiating discussion, the AAVSB decided to develop a separate model practice act, which it would distribute to its member boards.

Dr. Joan M. Samuels, AVMA Executive Board member and liaison to the ECFVG and Council on Education, said, "I'm disappointed the AVMA and AAVSB will not be able to work together on a model practice act and that there will be parallel acts, because not only veterinary state boards but also state veterinary medical associations use it."

The model practice act is more important than ever because complementary and alternative medicine, Internet medicine, e-commerce, and telemedicine must be addressed.