Competency-Based Veterinary Education: CBVE Framework

Part 1Competency-Based Veterinary Education:CBVE framework

March 2018Preparing future generations of highly qualified veterinary medical practitionersis one of our most fundamental responsibilities as educators. How can webe assured that, collectively, we are producing practice ready, entry-levelprofessionals who are educated to a common standard and ready to delivercompetent, professional care in a variety of clinical environments?We can ensure that our institutions meet the educational standards of performance articulated bythe AVMA Council on Education. We can examine student performance data on the North AmericanVeterinary Licensing Exam (NAVLE). But how can we create consensus for what constitutes a“practice-ready veterinarian?” And how do we know if our graduates are achieving this benchmark?Such were the questions facing the AAVMC Competency-Based Veterinary Education Working Groupwhen it was established in July 2015. The group began by systematically reviewing and analyzing thecontemporary literature in competency-based education throughout the health professions. Then, over32 months of coordinated work and dozens of virtual and face-to-face meetings, they constructed thisframework for competency-based outcomes assessment in veterinary medical education.The result of their labor represents one of the most substantial pedagogical projects everundertaken by the AAVMC. We invite the colleges and schools of veterinary medicine to considerthis framework as they update their professional curricula, whether they are making modestrefinements or undergoing a complete curriculum redesign.We are indebted to the CBVE Working Group for the enormous amount of time and effort theyinvested in this project. The framework they have produced will inform and enrich many differentaspects of our professional programs, and substantially foster the professional excellence we allseek in academic veterinary medicine.Andrew T. Maccabe, DVM, MPH, JDAAVMC Chief Executive Officer 2018 AAVMCaavmc.org/cbve

Competency-BasedVeterinary EducationCompetency-Based Veterinary Education (CBVE)is an approach modeled after competencybased medical education and is designed toprepare graduates for professional careers byconfirming their ability to meet the needs ofanimals and the expectations of society. Thisapproach focuses on outcomes-based andlearner-centered education and assessment.The CBVE framework consists of nine domainsof competence, each representing a groupof related abilities necessary for veterinarygraduates. Associated with each domainis a list of competencies, all of which areconsidered core for veterinary education. TheCBVE framework consists of 32 competencies,some of which lend themselves to assessmentin the clinical context, while others may be bestassessed in the pre-clinical curriculum.To better describe each competency,illustrative subcompetencies are provided asexamples of content that may be modified orrefined by individual schools. Subcompetenciesare more granular than competencies and canbe used to develop course or rotation objectivesand assessments.The CBVE framework provides a consistentfoundation for implementation in any veterinarycurriculum. A team of individuals known asthe AAVMC CBVE Working Group developedthis framework and associated EntrustableProfessional Activities (EPAs) which aredescribed in a separate document. Membersof this team include representatives fromveterinary colleges and schools across theU.S., Canada, Europe, the U.K. and some withexperience from Australia. The AAVMC CBVEwebsite provides resources on the frameworkand EPAs. Additional work products includingmilestones and assessment tools will beadded as they become available. Please see:aavmc.org/cbveCo-chairs: Laura Molgaard (University ofMinnesota) and Jennie Hodgson (Virginia Tech)Members: Harold Bok (Utrecht University),Kristin Chaney (Texas A&M University), JanIlkiw (University of California – Davis), SusanMatthew (Washington State University),Stephen May (Royal Veterinary College), EmmaRead (University of Calgary), Bonnie Rush(Kansas State University), Kathy Salisbury(Purdue University)Educational Consultant: Jody FrostAAVMC Staff Liaison: Ted MashimaMarch 20181

Suggested CitationAAVMC Working Group on Competency-Based Veterinary Education,Molgaard, L.K., Hodgson, J.L., Bok, H.G.J., Chaney, K.P., Ilkiw, J.E.,Matthew, S.M., May, S.A., Read, E.K., Rush, B.R., Salisbury, S.K. (2018)Competency-Based Veterinary Education: Part 1 - CBVE Framework.Washington, DC: Association of American Veterinary Medical Colleges.Questions, Suggestions and CommentsThe AAVMC’s Competency-Based Veterinary Education (CBVE) project is an ongoing,dynamic undertaking which will be continuously developed and enhanced.Suggestions and input from all sectors of academic veterinary medicine are welcome.If you have questions or suggestions about the CBVE project, please contact projectleadership by emailing CBVE@aavmc.org2aavmc.org/cbve

Key DefinitionsCompetencyAn observable ability of a health professional related to a specific activity thatintegrates knowledge, skills, values, and attitudes. Since competencies are observable,they can be measured and assessed to ensure their acquisition.1Domains of Competence (DOC)Broad distinguishable areas of competence that in the aggregate constitute ageneral descriptive framework for a profession.2Competency FrameworkAn organized and structured representation of a set of interrelatedand purposeful competencies.3Entrustable Professional Activity (EPA)An essential task of a discipline that a learner can be trusted to perform withlimited supervision in a given context and regulatory requirements, once sufficientcompetence has been demonstrated. (As adapted from4)MilestoneA defined, observable marker of an individual’s ability along a developmental continuum.41. Frank, J.R., Snell, L.S., Ten Cate, O., et al. (2010) Competency-based medical education:Theory to practice. Medical Teacher, 32(8), 638-645.2. Englander, R., Cameron, T., Ballard, A.J., et al. (2013) Toward a common taxonomy of competency domainsfor health professions and competencies for physicians. Academic Medicine, 88(8), 1-7.3. Willet T. (2012) Performance framework definitions [Internet]. [cited 2012 Dec 5]. Available erformance Framework - Definitions.4. Englander, R., Frank, J.R., Carracio, C., et al. (2017) Toward a shared language for competency-based education.Medical Teacher, 39(6), 582-587.3

Domains of Competence41Clinical Reasoning and Decision-making2Individual Animal Care and Management3Animal Population Care and Management4Public Health5Communication6Collaboration7 Professionalism and Professional Identity8Financial and Practice Management9 Scholarshipaavmc.org/cbve

DOMAIN 1Clinical Reasoningand Decision-makingThe graduate demonstrates critical thinkingand problem solving to arrive at evidence-baseddecisions that consider animal and client needs,available resources, and social Gathers and assimilatesrelevant informationabout animalsa.b.c.d.1.2Synthesizes andprioritizes problemsto arrive at differentialdiagnosesa. Identifies problemsb. Creates refined problem listc. Prioritizes differential diagnoses1.3Creates and adjustsa diagnostic and/ortreatment plan basedon available evidencea. Appraises available clinical informationand acts accordingly despite uncertaintyb. Explains justification for planc. Re-evaluates animal or populationin a timely manner to adjust pland. Uses critical thinking to determineappropriate action whenunexpected outcomes occur (e.g.,complications, changed diagnosis)Collects historyPerforms physical examinationInterprets diagnostic test resultsPerforms necropsy examination5

16Clinical Reasoning and CIES1.4Incorporates animalwelfare, clientexpectations, andeconomic considerationsinto the diagnosticor treatment plana. Considers disease in context ofthe whole animal and clientb. Presents a range of options to the clientc. Considers euthanasia as a managementoption when appropriate1.5Prioritizes situationalurgency and allocatesresourcesa. Triages cases to address most urgentand important problems firstb. Recognizes emergent situationand directs actionc. Recognizes and responds to reportable,transboundary, epizootic, andemerging/re-emerging diseases1.6Adapts knowledgeto varied scenariosand contextsa. Extrapolates knowledge tonovel species or situationsb. Adjusts existing protocol or procedurewhen standard measures are unavailable1.7Recognizes limitationsof knowledge, skilland resources andconsults as neededa. Identifies situations in whichreferral is warrantedb. Consults experts both within andoutside the veterinary professionaavmc.org/cbve

DOMAIN 2Individual Animal Careand ManagementThe graduate performs preventive, diagnostic, medical andsurgical procedures for the health, wellness and treatmentof animals, appropriate to the context and life rforms veterinaryprocedures and postprocedural carea. Performs elective procedures(e.g., castration)b. Performs routine therapeuticprocedures (e.g., administer fluids)c. Performs emergency procedures(e.g., establish an airway)d. Provides analgesia and postoperative caree. Anesthetizes and recovers patientsf. Manages patient comfort2.2Promotescomprehensive wellnessand preventive carea. Recommends diseaseprevention measuresb. Provides nutritional counselingappropriate to life stage and health statusc. Advises clients regardingroutine dental cared. Educates clients on prevention ofcommon behavioral problemse. Counsels clients about husbandryand welfare needs7

DOMAIN 3Animal PopulationCare and ManagementThe graduate designs and implements programs in herd/flock health, disease prevention and control to improve thehealth, welfare and productivity of animal ES3.1Applies populationmanagement principlesin compliance withlegal regulations andeconomic realitiesa. Recommends diseaseprevention measuresb. Advises on nutritional managementc. Recommends housing andhusbandry protocolsd. Designs therapeutic plans fordisease management3.2Recommends andevaluates protocolsfor biosecuritya. Develops isolation protocolsb. Selects disinfection protocolsc. Recommends protocols foranimal movement3.3Advises stakeholders onpractices that promoteanimal welfarea. Advocates for animal welfare throughcommunication of the physical, affectiveand natural needs of the animal. Explainsethical and welfare-related aspects ofproduction processes and slaughterb. Recognizes proper handling and/or adequate production facilitiesby interpretation of appropriateanimal behaviors. Advises onanimal husbandry and transportaavmc.org/cbve

DOMAIN 4Public HealthThe graduate responds to issues at the interface ofanimals, humans, and the environment, utilizing aglobal perspective and sensitivity to local 1Recognizes zoonoticdiseases and respondsaccordinglya. Identifies the clinical signs, clinicalcourse, transmission potentialand pathogen(s) associatedwith zoonotic diseasesb. Responds to zoonotic disease diagnosisthrough owner education, reporting,quarantine, and disinfection4.2Promotes the healthand safety of peopleand the environmenta. Makes recommendations formanagement of animal waste,carcasses, and by-productsb. Implements safety andinfection control practicesc. Advises on disaster/emergencypreparedness and responsed. Practices responsible use ofantimicrobial agentse. Describes the role of theveterinarian in food safety9