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Scoring the Clinical Proficiency Examination. Dr. Beth Sabin, Assistant Director AVMA Education and Research Division CLEAR Annual Conference September 16, 2005. Clinical Proficiency Examination. 3.5-day, 7-section, hands-on assessment of clinical veterinary medical skills

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Scoring the Clinical Proficiency Examination


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    1. Scoring the Clinical Proficiency Examination Dr. Beth Sabin, Assistant Director AVMA Education and Research Division CLEAR Annual Conference September 16, 2005

    2. Clinical Proficiency Examination • 3.5-day, 7-section, hands-on assessment of clinical veterinary medical skills • Must pass all sections • Administered at multiple ECFVG-approved sites according to Manual of Administration • Also administered by the Canadian National Examining Board (NEB)

    3. Educational Commission for Foreign Veterinary Graduates • Seven-member AVMA committee • Oversees educational equivalency assessment program • Candidates are graduates of international non–AVMA-accredited veterinary schools • Certificate holders meet educational prerequisite for licensure or employment

    4. ECFVG Program Steps • Enroll; proof of graduation • Assessment of English language competency (ETS, CAEL, IELTS) • Assessment of basic and clinical sciences knowledge (NAVLE) • Assessment of hands on clinical skills (CPE, postgraduate ECY)

    5. Clinical Proficiency Examination • 3.5-day, 7-section, hands-on assessment of clinical veterinary medical skills • Anesthesiology • Clinical and Anatomic Pathology • Equine Practice • Food Animal Practice • Radiology • Small Animal Practice • Surgery

    6. Clinical Proficiency Skills CPE Manual of Administration defines as: “…combination of knowledge and technical skills.” Examiner assesses knowledge by directly observing examinee behaviors as examinee performs basic skills required of a minimally competent entry-level practitioner.

    7. CPE Audit • Audit conducted in Spring 2001 • Findings provided to ECFVG Fall 2001 • CPE accomplishes the intended goal - it assesses the minimal clinical competency of a graduate of a non-accredited veterinary program • Suggestions for enhancements

    8. Post-audit CPE Activities • Examiners’ Training • Review of CPE Manual of Administration • Examiners’ Master Manual • Review of CPE scoring parameters • Survey of faculty and students

    9. CPE History • Experts selected most pertinent skills to evaluate performance competency • Scoring process defined • Goal is to separate “masters” from “non-masters” • Interested in evaluating for minimal competency

    10. Performance Benchmarks • Consider the behaviors to be observed and what constitutes minimal levels of performance at each CPE scoring level: • Superior • Good • Satisfactory • Unsatisfactory

    11. CPE Rating Scale(for six of seven sections) 100% - 86% Superior Superior performance of required clinical skills 85% - 71% Good Good performance of required clinical skills 70% - 61% Satisfactory Satisfactory performance of required clinical skills < 60% Unsatisfactory Failed to demonstrate the required clinical skills

    12. Development of Assessment Methods • Competencies identified for each section • Example—Clinical and Anatomic Pathology • Recognize and interpret visual images of gross pathological lesions • Perform a necropsy and take tissue samples for histopathology • Perform common laboratory tests and interpret results of those tests in the areas of clinical microbiology, clinical parasitology, hematology, and urinalysis

    13. Assessment of Skills • Skills/activities identified for each competency • Example—Perform necropsy • Thoroughly examine intact carcass • Opens carcass, examine major cavities, remove viscera and head • Examine major organs • Examine muscles, joints, bone marrow • Examine endocrine glands, lymph nodes

    14. Behavioral Anchors • Observable behaviors identified for each skill/activity • Example—Thoroughly examine intact carcass (5 pts) • 1 pt: Assesses general body condition/hydration • 1 pt: Examines skin/hair coat • 1 pt: Examines head • 1 pt: Examines limbs including feet • 1 pt: Examines perianal and genital region, mammary glands

    15. Calculating Section Scores • Determine weighting of each competency • Example—Clinical and Anatomic Pathology • Recognize and interpret visual images: 16% • Perform necropsy: 20% • Perform lab tests and interpret results: 64% • 16% for each of four areas • Sum weighted station scores = section score • Pass = 60

    16. CPE Rating Scale(for surgery) • 2004 review by subject matter experts and testing consultants • Minimal competency best assessed via pass/fail • Experts developed: • Check list of passing behaviors • Check list of failing behaviors • Appendix of fatal flaws

    17. Scoring Surgery CPE Manual states: • A “pass” = at least a minimally competent performance of entry-level surgical skills • Examiner to use the surgical skills assessment sheet as a checklist and to record positive and negative behaviors • Only feedback provided is in the case of a fatal flaw

    18. Surgery Competencies • Prepare the patient • Prepare self • Perform surgical procedure

    19. Surgical Skills • Asepsis • Ovariohysterectomy technique • Tissue trauma • Hemostasis

    20. Observable Behaviors Tissue trauma • Passing behaviors • Demonstrates atraumatic tissue handling throughout • Skills do not result in cumulative traumatic handling of tissue • Failing behaviors • Causes significant damage to other tissues/organs (fatal) • Skills result in cumulative traumatic handling of tissue

    21. Failing Surgery CPE Manual states: • Should a candidate exhibit any one behavior in the “Failing Behaviors” column of the assessment sheet, he/she will be allowed to complete the Surgery section but will receive a failing grade

    22. Fatal Flaws CPE Manual States: • Should the candidate commit a fatal flaw, the examiner will interrupt the examination, correct the error to ensure safety of the animal and personnel, and award the candidate a failing grade. • The candidate will not be allowed to complete the Surgery section of the CPE.

    23. Five Fatal Flaws • Fails to control significant hemorrhage • Fails to create a secure closure of the abdominal wall • Unable to achieve and maintain an aseptic field • Causes significant damage to other tissues/organs • Exhibits any other behavior that puts the animal’s life at risk

    24. Radiology • Ongoing review by subject matter experts • Development of consensus on types of radiographs and radiographic lesions • Asking experts: “What types of lesions should a minimally competent entry-level veterinarian be able to identify and in what species?”

    25. Goals of Radiology Review • Long-term • Develop a central bank of radiographs • Short-term • Update competencies, skills/activities, and observable behaviors for assessment of minimal entry-level competency in radiology

    26. Additional Information • ECFVG Web site • www.avma.org/education/ecfvg/default.asp • Contact ECFVG office • ECFVG@avma.org • 800-248-2862, ext 6675