Veterinary college accreditation: setting the record straight

Phillip D. Nelson Dean's Office, College of Veterinary Medicine, Western University of Health Sciences, Pomona, CA 91762.

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 DVM, PhD

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“One doesn't discover new lands without consenting to lose sight of the shore for a very long time.”

—Andre Gide

For more than 60 years, the AVMA Council on Education (COE) has been accrediting colleges of veterinary medicine in the United States and Canada. Accreditation by the COE represents the highest standard for veterinary medical education in these countries and assures all interested parties that accredited colleges meet nationally accepted standards of quality. The COE currently accredits all veterinary colleges in the United States and Canada and provides for accreditation of colleges in other countries that voluntarily seek such classification and meet or exceed all of the standard requirements.

For much of its history, the COE has operated with little evidence of overt controversy. More recently, however, with the accreditation of veterinary colleges in Mexico and the Caribbean and the accreditation of veterinary colleges that use a distributed model for clinical training of their students, rather than a traditional veterinary medical teaching hospital, questions have arisen as to whether the COE continues to uphold the highest standards in its accreditation decisions. Of particular note in this regard is the recent commentary by Dr. Robert Marshak1 questioning whether the COE has been too lenient in interpreting its accreditation standards and suggesting that several programs, including the Western University of Health Sciences College of Veterinary Medicine (WesternU-CVM), did not warrant a designation of full accreditation.

An important step in the COE accreditation process is the site visit, during which COE members visit the college to verify information provided by the college and obtain any additional information they might need to reach their decision. During my more than 30 years as an academician, both as a faculty member and as an administrator, at three academic institutions, I have experienced COE accreditation site visits several times. In addition, I have had primary responsibility for generating annual accreditation reports required by the COE for the past 17 years for two institutions, including WesternU-CVM. My experiences with the COE have never led me to conclude that accreditation decisions by the COE have been the result of permissive attitudes toward or inaccurate interpretations of the accreditation standards. If anything, my experiences in responding to COE concerns have been some of the most challenging of my career, and my interactions with COE members—particularly the more recent ones—have left me with the firm conviction that these individuals are deeply committed to upholding the standards of accreditation. I can think of a number of words to describe my experiences with the COE, but leniency and permissiveness would not be among them.

In reading some of the concerns that have been expressed regarding recent accreditation decisions by the COE, I believe that many of these concerns, particularly those pertaining to WesternU-CVM, are based on inaccurate information. To ensure that the accreditation process is conducted with integrity and objectivity and to encourage the colleges to be forthcoming and open, the COE has adopted a confidential process. This means that those outside the COE and the individual colleges seeking accreditation are unaware of any concerns the COE might have had and unaware of the evidence that led the COE to make any of its recent (or past) decisions. Although maintaining the confidentiality of the accreditation process is appropriate and necessary, it means that individuals outside the accrediting process may not know what actions any individual college has taken to address COE concerns and ensure that its program continues to meet or exceed the accreditation standards.

In particular, it strikes me that owing to the uniqueness of the WesternU-CVM curricular model, many in the veterinary community may not have received much information about it or may have received misleading information from other sources. Because the curricular model at WesternU-CVM is so novel, it likely is unfamiliar to most veterinarians. Therefore, a brief description of our curriculum may help alleviate specific concerns.

What We Do and Why We Do It

The founding dean and faculty members at WesternU-CVM sought to address several present-day academic challenges when designing the new curriculum. They wanted a curriculum that would promote lifelong, student-centered learning; cultivate appropriate learning behaviors; guarantee the development of an appropriate body of knowledge in comparative biologic principles; ensure adequate exposure to and training in routine diagnostic and therapeutic clinical skills; provide an environment where important concepts and principles could be presented and learned in the context of medical problems students would be likely to encounter after graduation; and, finally, provide a curriculum that would faithfully consider the intrinsic value of and reverence for life in all laboratory and classroom activities.

A problem-based learning approach was chosen by our founding faculty to inculcate behaviors in our students that foster critical thinking, analytic and evidence-based patient care, and lifelong learning. They realized that to fully reap the benefits of this problem-based learning approach, it needed to be fully implemented in the curriculum as an adult-learning paradigm. Therefore, throughout the first two years of the veterinary curriculum, lectures and laboratory exercises are coordinated each week with a focus on simulated patients.

The faculty has established learning objectives and major concepts for 12 traditional sciences ranging from basic science to clinical medicine, and we require students to demonstrate competence in each of these disciplines. We believe that the basic science knowledge that must be learned is contained in encounters with (and management of) the typical patients veterinarians see every day. With a veterinary patient as the central focus each week, there is a natural integration of basic science concepts, and use of simulated patients creates a clinical context from which these concepts may be recalled. To provide further validation of student competence in the 12 disciplines we monitor, we require second-year students to take an externally administered, high-stakes examination of basic veterinary science proficiency (the Qualifying Examination offered as part of the Program for the Assessment of Veterinary Education Equivalence) after their fourth semester. Student performance on this examination contributes to their final semester grade.

Importantly, through the use of the problem-based learning approach, students acquire more than scientific knowledge during their first four semesters at WesternU-CVM. Students are provided numerous opportunities to develop communication skills, socialization skills, appreciation for the complex contemporary issues veterinarians face, and the clinical and animal handling skills needed to transition safely into the clinical practice environments of curricular years three and four. We contend that the highly structured, faculty-coached learning experiences of the first two years are essential to successful implementation of the distributed model of clinical education that occurs during years three and four of the curriculum. Faculty coaching and the techniques involved in student-centered learning are also incorporated into the clinical years of the curriculum.

Year three of the veterinary curriculum at WesternU-CVM consists of 18 required courses that represent the diverse career choices a new graduate would typically pursue. Six of the courses are presented in on-campus classroom settings (ie, courses related to food and feed safety, population health and production, USDA accreditation and foreign animal diseases, veterinary and environmental public health, and practice management and a student presentation seminar), and the remaining 12 courses are presented in various multidoctor clinical practices (small animal, equine, food animal, and emergency medicine) and institutional practices (diagnostic pathology, laboratory animal medicine, and zoo animal medicine) where standards of practice are monitored by WesternU-CVM faculty members. Faculty course leaders visit the practices and communicate with the students in residence throughout each course. We are fortunate that a large number of outstanding veterinary practices are located in close proximity to our college. Preceptor veterinarians in each clinical setting collaborate with WesternU-CVM faculty course leaders to educate and evaluate individual veterinary students in each group. Students report their case experiences and degree of involvement in patient care to the supervising faculty member. Students typically see patients half-time each day and, the remainder of the day, pursue learning topics defined in the course syllabus and relevant to the practice setting as they prepare for course examinations, which are administered every eight weeks. The students learn independently and as a collaborative group through the use of skills they acquired during the problem-based learning phase of the curriculum. Faculty members from WesternU-CVM and preceptor veterinarians conduct rounds and discussions and monitor student progress. Clinical caseloads in these courses are typical of the general practice workplace that new graduates will experience.

In the fourth year of the curriculum, each student is assigned to various specialty practices where board-certified clinicians examine and treat complex surgical and internal medicine cases. Students may opt for either a large animal or small animal practice setting for these core course experiences. During these core courses, students are visited by WesternU-CVM faculty members who also conduct regular case rounds onsite or by video conferencing. Again, WesternU-CVM faculty course leaders and the preceptor veterinarians collaborate to evaluate student performance and monitor student progress. Students must also select six to eight additional specialty venues, subject to faculty approval, to pursue species-specific and career-specific education at the specialty practice level. Daily case logs must be maintained in a descriptive database that is regularly monitored and evaluated by WesternU-CVM faculty members.

Examining the Historical Perspective

Many of the changes in medical and, ultimately, veterinary education that have occurred in the past century are attributed to a 1910 report by Dr. Abraham Flexner.2–4 In that report, Flexner advocated training of physicians in analytic thinking, a clinical phase of education in an academically oriented hospital, and, as a result of daily patient care in conjunction with appropriately inquisitive faculty, the conduct of pertinent clinical research that involves students and clinicians. His recommendations are largely credited with stimulating the resultant changes that occurred in medical education in the early 1900s and in veterinary medical education in the latter half of the century.

There is no doubt that the changes seen during this transition period vastly improved veterinary care in the United States. No reasonable person would argue otherwise, and I certainly support the basic tenets of Flexner's recommendations (ie, training in analytic thinking, clinical training, and the incorporation of research as an integral part of the education process). However, I do not believe the resultant model is the final or only solution for veterinary education.

The application of Flexner's propositions did result in a vast improvement of the then-deplorable conditions within the veterinary community but not because they were rigid and doctrinaire. Quite the opposite was true. Flexner's revolutionary approach was so successful because it demanded that institutions evolve to suit the environment instead of avoiding change or ignoring the problems of the time. Even Flexner became concerned that 20 years after his report was issued, medical education had begun to overly focus on the assimilation of scientific knowledge at the expense of other important areas of medical education.4,5 If we were to restrict ourselves to the strict interpretation of Flexner's recommendations, I believe we would find ourselves unable to respond to the current obvious problems in veterinary education. Such an approach would be dubious because it does not take into account the academic, social, and economic environment within which those recommendations were written or the changes in those environments that have occurred since. I agree that the primary reason for the advances in veterinary education in the past century was the integration of teaching, research, and patient care. Moreover, I believe it is important to incorporate research methodologies as well as current research discoveries as a routine part of curricular enhancement. However, I believe it is myopic to ignore the challenges being faced by present-day veterinary faculty members who endeavor to provide professional training that achieves an appropriate balance in comparative biologic principles, practical clinical skills, clinical reasoning, and professional values.

Of course, one of the major challenges facing veterinary education today is the question of funding, particularly as this relates to student debt. However, I do not believe that economic concerns were the sole drivers behind the development of new educational models and techniques in veterinary education, including those used at WesternU-CVM. Rather, studies6 have suggested that the traditional curricular model may overemphasize the possession of scientific knowledge at the expense of providing adequate training in other, equally important areas, and new educational models are being developed to address these deficiencies.

Misinterpreting the Standards

Dr. Marshak1 and others have suggested that the COE should use the strictest interpretation when assessing whether a veterinary college meets its accreditation standards, but the standards have been specifically designed by the COE to maintain the highest educational standards yet still allow the individual veterinary colleges flexibility in determining how they go about meeting each standard. As an example, standard 1 states that “[a]n accredited college of veterinary medicine must be a part of an institution of higher learning….” In a strictly traditional sense, an institution of higher learning could be defined as “a community of scholars with many branches of advanced learning, including the foundational sciences (mathematics, physics, chemistry, and biology), the humanities, and the arts.”1 But this definition seems outdated and does not match the current understanding or current reality. In fact, the US Department of Education defines an institution of higher learning as an educational institution that admits as regular students only persons having a certificate of graduation from a school providing secondary education or the recognized equivalent, is legally authorized within its state to provide a program of education beyond secondary education, provides an educational program leading to the awarding of a bachelor's degree, is a public or other nonprofit institution, and is accredited by a nationally recognized accrediting agency or association.

Western University of Health Sciences is an independent, nonprofit academic health center dedicated to educating health-care professionals and is accredited by the Accrediting Commission for Senior Colleges and Universities of the Western Association of Schools and Colleges, a regional accrediting body recognized by the Council on Higher Education Accreditation and the US Department of Education. Clearly, therefore, Western University is an educational institution that meets the definition of an institution of higher learning. Although it may be tempting to substitute one's personal definition of an institution of higher learning when interpreting the accreditation standards, the COE, in requiring the colleges to meet national recognized standards, should depend on the definition provided by the US Department of Education.

It is my belief that the health sciences campus of which WesternU-CVM is a part creates a unique opportunity for interprofessional collaboration and education. Veterinary students at WesternU-CVM participate in scenario-based discussions with students and faculty of eight other health-care professions (physicians, pharmacists, nurses, physical therapists, optometrists, dentists, physician assistants, and podiatrists) to develop a vision of shared responsibility for public health. Scenarios include common maladies that occur in humans and animals as well as zoonotic diseases for which veterinary medicine is integral to the protection of human health. The students discover how healthcare information is managed and how the scope of their practice complements and supports other professions in our health-care systems. Just as important, students in the other health-care professions are exposed to the value and potential contributions of veterinary medicine in protecting public health. To suggest that this wealth of knowledge, interprofessional association, and productive synthesis is somehow less rewarding for students or produces substandard results merely because it does not include a particular set of disciplines historically used to define an institution of higher learning suggests that educational value is an objective concept easily encapsulated and fundamentally artless. Higher learning is no mere recipe; it is an ever expanding conversation promoting thought and growth toward an enlightened future, and Western University is proud of its contributions to this future.

It is not my intent to respond to every concern raised regarding COE's decision to accredit WesternU-CVM. It is difficult to condense the information needed for an adequate response to even one of the concerns raised in the recent commentary (the above example should be sufficient evidence). I am quite secure in our ability to address any of the concerns raised, standard by standard, as we did when visited by the COE every six months for four years. Instead I am extending an open invitation to anyone who may be interested to visit our college and university and see for themselves.

Final Thoughts

We genuinely owe a great thanks to our predecessors in veterinary medicine who built the profession and established the trust and confidence that exists between us and the society we serve. Service to the profession by individuals earned this stature for all of us. All aspects of veterinary medicine and other sciences made great strides in the aftermath of World War II because of the tremendous financial investments made by the state and federal governments and the investments of private enterprise. The veterinary profession and veterinary educators were fully engaged in this scientific boom and contributed mightily to the expansion of knowledge as they applied new technologies and theoretical advances to the care of their patients. Clinician educators within institutions of higher learning and from all sectors of our profession will continue to advance our collective cause by adapting to new circumstances and redefining the state of the art.

The success of our approach to veterinary education at WesternU-CVM is reflected in many of the traditional outcomes. Student retention, performance on the North American Veterinary Licensing Examination, employer satisfaction, performance in postgraduate internship and residency programs, and alumni satisfaction have met or exceeded expectations. In our opinion, the accreditation standards have been scrupulously evaluated in our context by the COE over the past 10 years, and the alternative approaches we have implemented have fully met the intention and specification without compromise in each case. In some sense we are pioneers, but we remain fully aware of our obligation to the profession, and we appreciate the intended purpose of any recommendations and critiques by our colleagues on the COE.

It is true that given the fast-evolving scientific milieu, no veterinary curriculum can turn out fully fledged veterinary graduates with an inclusive knowledge of all professional requirements at the end of a four-year program. Our veterinary degree programs are akin to ground school for airline pilots: much is yet to be learned while actually flying. I believe that the primary purpose of today's veterinary educational programs is to train students so that they learn to gather and assess data accurately. This means that our educational strategy must inculcate appropriate behaviors in our graduates that foster independent lifelong learning. As taxpayer subsidies for professional education diminish, the financial burden inevitably shifts to the students, many of whom now graduate with crushing debt. Outstanding clinician educators have already begun an outward migration into nontraditional, nonacademic partnerships. As caseloads in teaching hospitals shrink and clients shift to efficient, well-equipped private practices, the learning experience students once enjoyed in teaching hospitals must likewise shift or suffer. We are in a transition period, and the profession must consider alternatives but still maintain the standards we have thus far established. The distributed clinical education model used at WesternU-CVM liberates us from schoolhouse walls and challenges the mentality that holds that academia is the only suitable environment for learning. Evidence of this transition can be seen in the recent report of the North American Veterinary Medical Education Consortium and the progress that has been made in intercollegiate collaborations such as the Veterinary Internet Content Exchange and Veterinary Education Worldwide.

It has been suggested by some that certain entities within our profession be barred from participating as members of the COE in the accreditation process.1 There are real concerns for the future of veterinary education and, ultimately, the profession. In facing our challenges, however, we should not exclude perspectives outside of academia or those outside the borders of our limited geography. We need to embrace our worldwide interdependence and the one-health, one-medicine concept. We expect the COE to be transparent and eschew influence, but in my experience, the members of the COE are not blind to the potential for unscrupulous motives among those seeking accreditation, and sequestering the COE from the leadership in our profession would not better inform their decisions. Caution and transparency are warranted, not isolation and paralysis.

The 11 standards that guide the COE in their accreditation decisions were written by thoughtful leaders and are reviewed regularly at least every four years. The standards must be subject to interpretation because they are applied to a variety of veterinary colleges with unique academic settings and regional missions and diverse constituencies. The COE should not mandate compliance with an unalterable model intended to produce identically structured colleges of veterinary medicine that are similar to the existing ones, and contemporary judgment must be applied to adjust for context and the evolution of societal needs.

The saying that “a rising tide lifts all boats” is apt for those veterinary educational programs in other countries seeking validation through COE accreditation. Better animal health in all countries throughout the world is a benefit to our nation as well as all humankind. Foreign schools seeking COE accreditation pay the full cost of the evaluation process and must convincingly show that they have met, in a sustained fashion, the standards that have been set. The investment in promoting quality standards worldwide should be viewed as our duty as world leaders in veterinary medicine. We should not fear a tide of well-educated foreign veterinarians so much as we should fear an undetected zoonotic disease reaching our shores or breaching our borders.

The reality is, times change. Veterinary education changed dramatically in the past century in response to the needs of society and available technologies. We must be prepared to embrace change going forward with the same wisdom and insight. Solving the challenges that beset our profession will require expansive collaboration between veterinary institutions that have operated in relative isolation in the past. New partnerships will lead to better informed recommendations for change, efficient leveraging of limited resources, and a more cohesive response by the veterinary profession. The Western U-CVM intends to be a valuable partner in these efforts.

References

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    Marshak RR. Veterinary school accreditation: on a slippery slope? J Am Vet Med Assoc 2011;239:11831187.

  • 2.

    Bonner T. Iconoclast: Abraham Flexner and a life in learning. Baltimore: John Hopkins University Press, 2002.

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    Lagemann E. Private power for the public good. A history of the Carnegie Foundation for the Advancement of Teaching. Middletown, Conn: Wesleyan University Press, 1983.

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    Flexner A. Medical education in the United States and Canada: a report to the Carnegie Foundation for the Advancement of Teaching. New York: Carnegie Foundation for the Advancement of Teaching, 1910.

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  • 5.

    Flexner A. Medical education: a comparative study. New York: MacMillan, 1925.

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    Cooke M, Irby DM, Sullivan W, et al. American medical education 100 years after the Flexner report. N Engl J Med 2006; 355:13391344.

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