Speaking different languages

Foreign veterinary school accreditation stirs debate
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The Universidad Nacional Autonoma de México Facultad de Medicina Veterinaria y Zootecnia has pursued an important goal for nearly 15 years: AVMA Council on Education accreditation (see story).

The Mexico City-based veterinary school has made great strides in that time, but as of the council's most recent meeting, has apparently not yet reached its goal.

Meanwhile, a handful of U.S. veterinarians have criticized the council for even considering granting the school accreditation. This unprecedented backlash, however, hasn't set well with supporters of international accreditation by the COE.

The Universidad Nacional Autonoma de México in Mexico City is one of the most artistically detailed universities in the Western Hemisphere.

"Anybody who's anybody"

Like many other foreign veterinary schools, UNAM operates differently from its U.S. and Canadian counterparts.

Veterinary students enter the university following high school and complete a five-year program. (Certain other COE-accredited programs, such as those at Murdoch University in Australia and the University of Edinburgh in Scotland, are similarly structured.)

Mexican students pay a nominal fee to attend UNAM, which relies heavily on federal funding. (This is similar to the situation for Massey University in New Zealand and the University of Utrecht in the Netherlands, where tuition fees for domestic students are subsidized entirely or partly by the government.)

UNAM does take an uncommon approach with its admissions. Dr. Carlos F. Rodriguez, an associate at Tulare Veterinary Hospital in Tulare, Calif., and a 1993 graduate of the veterinary school, explained.

"A lot of people get accepted, but few walk away with a degree," Dr. Rodriguez said. Typically hundreds of students enter a class each year, but a sizeable percentage do not graduate. "It does have a good filter system. It's just a different way of doing things."

Dr. Rodriguez emphasized that "anybody who's anybody" in Latin America studies at UNAM, because it is considered one of the premier schools in that region—if not the best.

"I think it's getting better, but when I went there, we were behind the times compared to U.S. schools," he said. "With the basic sciences like pathology, immunology, and all the stuff that comes from books—it is a top-notch kind of education. But when it comes to putting everything in practice, I believe it lacked a lot. But that was more than 15 years ago. Lots of money has been going into developing those areas as far as training students."

UNAM is currently accredited by Mexico's National Council of Education for Veterinary Medicine and Zootechnics, or CONEVET. Sixteen veterinary schools are accredited by the organization, which also certifies veterinarians. The school first expressed interest in COE accreditation in 1996, a year after CONEVET was formed.

Dr. George H. Cardinet Jr. is a former COE member who served on the council from 1997-2004. He served on site visits to schools and colleges in Australia, France, and Mexico during his term. Dr. Cardinet also participated as an observer on three CONEVET veterinary school accreditation reviews and an unofficial visit to UNAM; his last visit was in 2003. He echoed Dr. Rodriguez's assessment that the veterinary school continues to improve.

"(UNAM has) many facilities that are not significantly different than what you would find at an average veterinary school in the states, such as laboratories and lecture halls, as well as the rudiments of a clinical facility," Dr. Cardinet said.

He said he didn't have sufficient time to get a good sense of the clinical program but that at the time, it appeared it wasn't at the same level as U.S. colleges with regard to caseload.

"I've heard secondhand they've improved their clinical facilities and program with monies granted by Banfield and the like, so that my comments that date back to things in 2003 may not reflect the situation today," he said.

Building a foundation

Banfield, The Pet Hospital, has aided UNAM's efforts to comply with COE standards in the area of small animal medicine.

The Portland, Ore.-based small animal veterinary hospital network built a full-service, 12,000-square-foot small animal teaching hospital on the school's campus, completed in 2005. The primary care facility is designed to handle a high volume of patients and offer 24-hour care. It has nine examination rooms, an in-house laboratory, and a large surgical suite.

Banfield also funded the renovation of UNAM's teaching hospital, which was developed into a specialty hospital, and a language laboratory for the school's students to learn English as a second language.

UNAM’s teaching hospital

John Payne, CEO of Banfield and former president of Bayer Animal Health North America, said Banfield's interest in helping UNAM dates back to when he first met the school's dean, Dr. Francisco Trigo Travera, in 1996. (Dr. Trigo declined to comment for this article.)

"I had a very favorable impression of what Dr. Trigo wanted to accomplish, and I strongly recommended to Banfield at that particular time that they get involved and help UNAM get accredited, and so that's how it all came about," Payne said.

He continued, "Obviously our board was very interested in expanding our practice in the United States and also in Canada and Mexico. Of course, Canada has very adverse laws that prohibit, in a lot of instances, our type of practice, but Mexico does not, and we wanted to expand in Mexico, and so the first natural thought was, 'Well, let's help UNAM with a facility.'"

Banfield's dedication to cultural and ethnic diversity also made the decision a natural one. Its veterinary hospitals are staffed by veterinarians from well over 100 veterinary schools.

Payne cited the ever-increasing Latin American population in the United States but the continuously low enrollment of Spanish-speaking students in U.S. veterinary schools as a real problem that can't be resolved without serious work.

Payne applauded the AVMA for "not being protectionist, but reaching out to the world and saying we believe we have the highest standards in veterinary medicine and we'd be happy for you to meet those standards and be accredited. I think that's a fantastic goal."

Differences of opinion

Graduates of COE-accredited foreign veterinary schools who wish to practice in the United States are generally not required to go through the AVMA Educational Commission for Foreign Veterinary Graduates program or the American Association of Veterinary State Boards' Program for the Assessment of Veterinary Education Equivalence. However, they still must pass national and state licensing examinations and must adhere to all U.S. immigration laws.

Yet, not everyone agrees accreditation of UNAM would be a good idea.

Dr. Paul D. Pion is president and co-founder of the Veterinary Information Network, a Web site dedicated to the veterinary profession. On the site, specifically VIN's message boards, Dr. Pion and others have lambasted the COE for considering UNAM for accreditation.

In an interview with JAVMA, Dr. Pion explained that although he hasn't yet visited UNAM, he's been told by colleagues who have lectured at the institution's veterinary school that it's unrealistic to expect UNAM graduates on the whole to be equivalent to U.S. veterinary school graduates in the field of small animal medicine.

He is concerned that AVMA-COE accreditation, "backed by millions of dollars from Banfield, is meant to encourage UNAM students to pursue a career in small animal medicine in Banfield clinics" in the United States.

UNAM students

"If I believed this would raise the level of small animal practice in Mexico or increase opportunities at home for our colleagues in Mexico, I'd not be as concerned," Dr. Pion said. "But it is not possible to find employment practicing high-quality small animal medicine there, other than in a very small number of practices serving the very wealthy or tourists."

Consequently, he predicts that UNAM graduates wishing to pursue small animal medicine of the standard that is practiced in the United States would be encouraged to emigrate here with the help of Banfield, which needs personnel to staff its growing practices.

"AVMA accreditation makes choosing to cross the border much easier. And in today's job market, if (UNAM graduates) come here to work for Banfield, they're basically indentured servants, because they will need that job to stay in this country. In addition, they don't have the debt our kids have. That creates an unlevel playing field."

Payne countered that Banfield has had no problem hiring quality veterinarians.

Dr. Pion's comments haven't been limited to UNAM. Tuskegee University officials circulated to its alumni a remark made by Dr. Pion in late January that, with regard to the COE standards of accreditation, "Tuskegee would never pass if truly held to the standard (I've never been there, so can't speak from personal experience)."

Dr. Tsegaye Habtemariam, dean of the Tuskegee School of Veterinary Medicine, said, "When I read his statement, I was surprised and deeply disappointed, because it was basically untrue and an exaggeration and misinformation at best."

Tuskegee veterinary graduates have excelled in many areas of the profession, Dean Habtemariam said, from academia to government to private industry.

"I do not know Dr. Pion or what his motivations are, but I know the outcome of his statement. It indicates he is a closed-minded person who is not in the 21st century, and he does not see what I consider are the underpinnings of the profession, which are ethical and moral activities," Dean Habtemariam said.

Dr. Ruby L. Perry, associate dean for academic affairs at the Tuskegee veterinary school, was equally dismayed.

"When you make third-party statements, it can be very damaging, especially in an area where it's been read by such a large audience. People take that information to be true. It just fosters miscommunication and shows ignorance of the roles of the Department of Education and the COE," Dr. Perry said.

Global perspective

The AVMA and COE also haven't taken Dr. Pion and his followers' criticism lightly.

The AVMA Executive Board will focus on the topic of foreign veterinary school accreditation during strategic discussions at its June 10-12 meeting at Association headquarters.

In addition, the board plans to vote on a recommendation to reaffirm the AVMA's existing policy that states the Association will accept a leadership role in international veterinary medicine.

The AVMA Committee on International Veterinary Affairs submitted the recommendation, which was supported by the COE at its spring meeting.

In the recommendation's background, the CIVA responded to Dr. Pion's accusations that, among other things, accreditation of UNAM has the potential to negatively impact the U.S. veterinary profession, in part, according to Dr. Pion, because of a perception that educational standards would be lowered and veterinary jobs would be lost to foreign-educated veterinarians willing to work for lower salaries.

UNAM clinic

"The CIVA believes that it is beyond the purview of an accrediting entity to withhold the opportunity for accreditation based on an unknown potential negative economic impact on any given profession. So doing appears to the CIVA to be unethical and unfair," according to the background.

The recommendation's background also notes "that regardless of where a veterinary school is located, the COE applies the same 11 standards of accreditation and assesses each school's compliance with those standards in the same manner. Moreover, all accreditation decisions are made by the COE alone, with no influence from other AVMA entities, including the Executive Board and House of Delegates, or outside entity."

Dr. Cardinet said in his time on the council, there were external influences relevant to issues the council made decisions on; however, as a council member, he felt quite shielded from that.

"It may have been going on at other levels, but I felt the group of people whom I was working with were independent, free-thinking, and motivated to apply the accreditation standards as they understood them, and acted accordingly," Dr. Cardinet added. "I wasn't aware of folks operating under the influence of external forces. I didn't feel anyone was telling me what to do or encouraging me to do something."

Back then, the council generally felt it was worthwhile to consider accrediting foreign veterinary schools, Dr. Cardinet said, in that it could open an equal opportunity to U.S. graduates as well as foreign graduates to practice where they'd like.

"It would seem to me that the yardstick for Mexico shouldn't be any different from Lyon or Melbourne or on our other border with Canada … we have accreditation standards that need to be applied equally and equitably. Not everyone will agree," he said.

On several fronts, there have been various attempts to create common international standards for veterinary education, and the AVMA is a key player in those efforts. One such effort is being led by the World Organisation for Animal Health (OIE), which is hoping to create minimum global standards for veterinary education (see JAVMA, April 1, 2010).

AVMA CEO W. Ron DeHaven said, "Ultimately, we can either let these efforts evolve on their own and potentially be subject to international standards created by others, or we can work to establish AVMA-COE accreditation as the gold standard for others to strive to attain."

Mexican veterinary school appealing COE decision

A Mexican veterinary school is appealing an adverse decision made by the AVMA Council on Education at its Feb. 28-March 2 meeting in Schaumburg, Ill.

Word of the appeal came within the required 30 days after the Universidad Nacional Autonoma de México Facultad de Medicina Veterinaria y Zootecnia had been notified of the council's decision.

Accreditation decisions are confidential until they become final; however, an appeal is considered a matter of public record.

An appeal by a foreign veterinary school not already accredited by the COE can be interpreted two ways: the school was either denied initial accreditation and is petitioning for reconsideration or was granted limited accreditation and is petitioning for full.

Now that UNAM is petitioning for review, the school has 60 days from when it was notified of the adverse decision to submit information supporting its petition, according to the council's accreditation policies and procedures.

Meanwhile, the AVMA Executive Board will appoint a panel that will hold a hearing on the matter within 120 days after receipt of information supporting the petition.

The last time a veterinary school or college appealed a COE decision was in 2000, when the Western University of Health Sciences filed an appeal.

For more information on the appeals process, visit here.

UNAM first expressed interest in COE accreditation in 1996. Since then it has been working to bring the school up to COE standards.

In spring 2006, the COE made a consultative site visit to Mexico City, and, afterward, laid out recommendations for UNAM to implement to work toward accreditation. The school sent a video more than a year later for the COE to view showcasing the completion of curriculum and facilities upgrades designed to meet conditions cited by COE officials in the 2006 consultative site visit report.

Additional interim reports provided by UNAM and reviewed by the COE resulted in the council granting a request from the college for a comprehensive site visit, which occurred in November 2009.

Past is prologue

For more than 60 years, the AVMA Council on Education has accredited foreign veterinary schools and colleges. They now constitute a third of all COE-accredited schools, with most located in the United Kingdom, Australia, and Canada.

The Faculteit der Diergeneeskunde, Rijksuniversiteit te Utrecht in the Netherlands was the first veterinary school outside the United States and Canada to receive COE accreditation, in 1973.

By the mid-90s, the growing international demand for COE accreditation required additional staff, volunteer time, and expertise. The council recognized that an assessment was needed to address the impact on the domestic accreditation process and educational standards in general.

The COE and the AVMA Executive Board also believed the potential impact of a further increase in international accreditation activities had not yet been fully understood. So in July 1997, the COE suspended consideration of any new applications for evaluation and approval of veterinary schools outside the United States and Canada.

The council spent a year discussing its role in international accreditation. In April 1998, the COE submitted three recommendations to the board that were subsequently approved:

  • Establish a task force to study the approval process for veterinary colleges outside the United States and Canada charged with discussing AVMA's future roles and responsibilities with regard to enhancing the educational process.
  • Modify the "Approval of Veterinary Colleges Outside the United States and Canada" as it appeared in the then-current COE Polices and Procedures Manual to introduce full cost recovery for accreditation expenses and for site visit and annual administrative fees.
  • Send a COE member to participate in a 1998 meeting at the Center for Quality Assurance in International Education titled "The Foundations of Globalization in Higher Education and the Professions" to ensure the council stayed fully informed on issues impacting professional education.

The Task Force on Foreign Veterinary Medical Education had two recommendations for the board in April 1999: Resume accepting applications for approval from veterinary colleges outside the United States and Canada, and accept an AVMA leadership role in international veterinary medicine. These were also approved.

In the background for the recommendations, the task force reasoned that the council had established mechanisms for full cost recovery associated with international accreditation and that resumption of the approval process is "consistent with trade agreements, which call for mutually acceptable objective criteria for recognition."

Also, the task force believed that global economics, expansion in the trade of animals and animal products, and the continuing emergence and spread of diseases without respect for national borders mandated an increased role for the AVMA and its members on the international veterinary scene.

Following these board actions, the COE developed enhanced policies and procedures for international accreditation in accordance with the best practices of the Council on Higher Education Accreditation, Association of Specialized and Professional Accreditors, and other U.S. Department of Education-recognized accrediting agencies that conduct international accreditation activities. These policies and procedures remain in place today.