Using the Five Core Components of Competency-Based Medical Education to Support Implementation of CBVE.

In recent years, veterinary education has begun the transition to competency-based models, recognizing that, like medical education, our goals include improved patient and client outcomes and the importance of learner-centered methods in education. Given that implementation of competency-based veterinary education (CBVE) is still in its relative infancy across many veterinary programs, we stand to gain from a unified approach to its implementation. As a guideline, the five core components of competency-based medical education (CBME) should serve to ensure and maintain fidelity of the original design of outcomes-based education during implementation of CBVE. Identified the essential and indispensable elements of CBME which include 1) clearly articulated outcome competencies required for practice, 2) sequenced progression of competencies and their developmental markers, 3) tailored learning experiences that facilitate the acquisition of competencies, 4) competency-focused instruction that promotes the acquisition of competencies, and 5) programmatic assessment. This review advocates the adoption of the principles contained in the five core components of CBME, outlines the approach to implementation of CBVE based upon the five core components, and addresses the key differences between veterinary and medical education which may serve as challenges to ensuring fidelity of CBVE during implementation.

Effectiveness of a digital interactive multimedia tutorial for preparing veterinary students to perform ultrasonography in horses.

OBJECTIVE: To determine the effectiveness of a digital interactive multimedia tutorial (DIMT) for preparing veterinary students to perform ultrasonography in horses. SAMPLE: 42 third-year veterinary students. PROCEDURES: Students were randomly assigned to 3 instructional methods: independent study (ie, 45 minutes to read a highlighted textbook chapter), lecture (ie, 45-minute lecture by a faculty member), or digital interactive multimedia tutorial (DIMT; ie, 45-minute narrated, interactive module). Written and practical tests were administered after each instruction session. For the practical test, each student was required to obtain a series of ultrasound images of a live horse, and images were later scored for quality by an individual unaware of the instructional method used. RESULTS: Higher-quality ultrasound images were obtained by veterinary students who had reviewed the DIMT rather than the analogous information in textbook chapters. No difference in scores was identified between students in the lecture group and those in the DIMT group. Students' perceptions suggested that practical instruction facilitated by clinicians was a key component of learning how to perform ultrasonography in horses. CONCLUSIONS AND CLINICAL RELEVANCE: Results supported the use of DIMTs in preparing veterinary students to perform ultrasonography in horses.

The Effects of Content Delivery Methods on Ultrasound Knobology and Image Quality Recognition Training in First-Year Veterinary Students.

As new technologies are incorporated into the practice of veterinary medicine, it is imperative we utilize the most effective and impactful content delivery methods. Ultrasound technology has become more affordable and compact for veterinary hospitals, leading to easier incorporation into practice. This study compares three methods of delivering ultrasound knobology content to first-year veterinary students at Texas A&M University College of Veterinary Medicine and Biomedical Sciences. In a prospective study, first-year veterinary students were randomly selected to receive one of three content delivery methods: self-directed active learning (SDL), in-person instructor demonstration, or online module instruction. Knowledge acquisition was assessed using a 10-question quiz for short-term understanding followed by a 10-question quiz after a 6-week period to assess long-term knowledge retention. Student demographics were analyzed using the Chi-square test. Quiz scores were analyzed between groups using Kruskal-Wallis tests followed by Dunn's post-tests for multiple comparisons. Values of p ≤ .05 were considered significant. On the short-term and retention quiz questions, students participating in SDL scored significantly higher (10 [5-10]) than those receiving in-person instructor demonstration (9 [3-10] p = .01 and 8 [2-10] p = .0004, respectively) or the online module instruction training (Group C) (6 [1-10] p < 0.0001 and 8 [4-10] p < .001, respectively). Based on quiz scores, veterinary students exhibited better ultrasound knobology and image quality recognition proficiency immediately and at 6-weeks following SDL when compared with other content delivery methods. Self-directed learning methods are recommended when teaching ultrasonography to veterinary students.

Collaborative Development of a Shared Framework for Competency-Based Veterinary Education.

Competency-based medical education is an educational innovation implemented in health professions worldwide as a means to ensure graduates meet patient and societal needs. The focus on student-centered education and programmatic outcomes offers a series of benefits to learners, institutions and society. However, efforts to establish a shared, comprehensive competency-based framework in veterinary education have lagged. This article reports on the development and outcome of a competency-based veterinary education (CBVE) framework created through multi-institutional collaboration with international input from veterinary educators and veterinary educational leaders. The CBVE Framework is designed to reflect the competencies expected of new graduates from member institutions of the Association of American Veterinary Medical Colleges (AAVMC). The CBVE Framework consists of nine domains of competence and 32 competencies, each supplemented with illustrative sub-competencies to guide veterinary schools in implementing competency-based education in their local context. The nine domains of competence are: clinical reasoning and decision-making; individual animal care and management; animal population care and management; public health; communication; collaboration; professionalism and professional identity; financial and practice management; and scholarship. Developed through diverse input to facilitate broad adoption, the CBVE Framework provides the foundation for competency-based curricula and outcomes assessment in veterinary education internationally. We believe that other groups seeking to design a collective product for broad adoption might find useful the methods used to develop the CBVE Framework, including establishing expertise diversity within a small-to-medium size working group, soliciting progressive input and feedback from stakeholders, and engaging in consensus building and critical reflection throughout the development process.

Collaborative Development of Core Entrustable Professional Activities for Veterinary Education.

Entrustable professional activities (EPAs) have been proposed as a practical framework for the implementation of competency-based education. As veterinary education moves toward a competency-based approach, core EPAs provide a context for assessment of workplace activities. This article reports on the development of eight core clinical EPAs for veterinary education created through multi-institutional collaboration, with international input from veterinary educators and veterinary educational leaders. These core EPAs are intended as minimal expectations for clinical activities that should be assessed for every graduate of Association of American Veterinary Medical Colleges member institutions. Adoption of the core EPAs and the associated Competency-Based Veterinary Education (CBVE) framework by veterinary schools is intended to promote Day One graduate competence and thereby enhance patient care and client service.

Development of core entrustable professional activities linked to a competency-based veterinary education framework.

Purpose: Despite the adoption of competency-based education in some veterinary schools over the past 15 years, only recently has a concerted effort been directed toward this in veterinary education internationally.Methods: In 2015, educational leaders from the Association of American Veterinary Medical Colleges (AAVMC) member schools came together with a strong call to action to create shared tools for clinical competency assessment.Results: This resulted in the formation of the AAVMC Competency-Based Veterinary Education (CBVE) Working Group, which then embarked on the creation of a shared competency framework and the development of eight core entrustable professional activities (EPAs) linked to this framework.Conclusions: This paper will report on the development of these EPAs and their integration with the concurrently-developed CBVE Framework.

Curriculum Redesign in Veterinary Medicine: Part I.

Curricular review is considered a necessary component for growth and enhancement of academic programs and requires time, energy, creativity, and persistence from both faculty and administration. At Texas A&M College of Veterinary Medicine & Biomedical Sciences (TAMU), the faculty and administration partnered with the university's Center for Teaching Excellence to create a faculty-driven, data-enhanced curricular redesign process. The 8-step process begins with the formation of a dedicated faculty curriculum design team to drive the redesign process and to support the college curriculum committee. The next steps include defining graduate outcomes and mapping the current curriculum to identify gaps and redundancies across the curriculum. Data are collected from internal and external stakeholders including veterinary students, faculty, alumni, and employers of graduates. Data collected through curriculum mapping and stakeholder engagement substantiate the curriculum redesign. The guidelines, supporting documents, and 8-step process developed at TAMU are provided to assist other veterinary schools in successful curricular redesign. This is the first of a two-part report that provides the background, context, and description of the process for charting the course for curricular change. The process involves defining expected learning outcomes for new graduates, conducting a curriculum mapping exercise, and collecting stakeholder data for curricular evaluation (steps 1-4). The second part of the report describes the development of rubrics that were applied to the graduate learning outcomes (steps 5-8) and engagement of faculty during the implementation phases of data-driven curriculum change.

Curriculum Redesign in Veterinary Medicine: Part II.

Curricular review is considered a necessary component for growth and enhancement of academic programs and requires time, energy, creativity, and persistence from both faculty and administration. On a larger scale, a comprehensive redesign effort involves forming a dedicated faculty redesign team, developing program learning outcomes, mapping the existing curriculum, and reviewing the curriculum in light of collected stakeholder data. The faculty of the Texas A&M University College of Veterinary Medicine & Biomedical Sciences (TAMU) recently embarked on a comprehensive curriculum redesign effort through partnership with the university's Center for Teaching Excellence. Using a previously developed evidence-based model of program redesign, TAMU created a process for use in veterinary medical education, which is described in detail in the first part of this article series. An additional component of the redesign process that is understated, yet vital for success, is faculty buy-in and support. Without faculty engagement, implementation of data-driven curricular changes stemming from program evaluation may be challenging. This second part of the article series describes the methodology for encouraging faculty engagement through the final steps of the redesign initiative and the lessons learned by TAMU through the redesign process.

Spurious hypercreatininemia: 28 neonatal foals (2000-2008).

OBJECTIVES: To (1) determine the occurrence of spurious hypercreatininemia in a population of hospitalized foals<2 days old, (2) assess the resolution of the hypercreatininemia, and (3) determine its association with survival in these foals. DESIGN: Retrospective case series. SETTING: 2 Referral hospitals. ANIMALS: Foals<2 days old with an admission creatinine>442 micromol/L (>5.0 mg/dL) from 2 referral hospitals. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The medical records of 33 foals were reviewed. Twenty-eight had spurious hypercreatininemia and 5 had acute renal failure. Admission creatinine was not significantly different between the 2 groups (mean [standard deviation]). The creatinine was 1,202 micromol/L (663 micromol/L) (13.6 mg/dL [7.5 mg/dL]) versus 1,185 micromol/L (787 micromol/L) (13.4 mg/dL [8.9 mg/d]) (P=0.96) in each group, respectively, though BUN at the time of hospital admission was significantly higher for acute renal failure foals (P=0.009). In the spurious group, serum creatinine at admission decreased to 504 micromol/L (380 micromol/L) (5.7 mg/dL [4.3 mg/dL]) by 24 hours, and to 159 micromol/L (80 micromol/L) (1.8 mg/dL [0.9 mg/dL]) at 48 hours, and to 115 micromol/L (44 micromol/L) (1.3 mg/dL [0.5 mg/dL]) at 72 hours. Twenty-three of 28 foals with spurious hypercreatininemia survived to hospital discharge and there was no difference in mean admission creatinine between survivors (1176 micromol/L [628 micromol/L]) (13.3 mg/dL [7.1 mg/dL]) and nonsurvivors (1308 micromol/L [857 micromol/L]) (14.8 mg/dL [9.7 mg/dL]) (P=0.67). Twenty of 28 foals had clinical signs suggestive of neonatal encephalopathy. CONCLUSION: Creatinine decreased by >50% within the initial 24 hours of standard neonatal therapy and was within the reference interval in all but 1 foal within 72 hours of hospitalization. The diagnosis of neonatal encephalopathy was common in these foals.

Prevalence of and risk factors for postoperative ileus after small intestinal surgery in two hundred and thirty-three horses.

OBJECTIVES: To determine the incidence of postoperative ileus (POI) in a population of horses after small intestinal surgery and the effect of multiple variables on development of POI. STUDY DESIGN: Case series. ANIMALS: Horses (n=233) aged > or =1 year that had exploratory celiotomy for small intestinal disease that recovered from surgery from 1995 to 2005. METHODS: Sixty-eight variables were collected from medical records (1995-2005) for each horse. POI was defined as nasogastric reflux volume >20 L over 24 hours or >8 L at any single time after surgery. RESULTS: Twenty-seven percent (64/233) of horses developed POI; 29 of 64 (46%) horses with POI had duodenitis proximal jejunitis (DPJ). When no intestinal resection was required at surgery, excluding horses with DPJ, 15% of horses had POI; 30% horses had POI after intestinal resection. Ten percent of horses had POI for >24 hours. When horses with DPJ were excluded, factors associated with increased risk of POI included high packed cell volume at hospital admission (P=.024), increasing age (P=.0004), and length of intestinal resection (P=.05). CONCLUSIONS: Risk factors for POI in this study were nonspecific although horses with intestinal resection are at higher risk compared with horses without intestinal resection. CLINICAL RELEVANCE: Predicting with certainty which cases will develop POI remains elusive.

Congenital anomalies of the equine urinary tract.

Congenital anomalies of the urinary tract in horses may be difficult to diagnose and treat. Presenting complaints are variable and include weight loss, depression, dysuria, hematuria, and mild colic. Although the most severe abnormalities are diagnosed in the neonate, some diseases, such as ectopic ureter(s), may be identified in older horses. In human medicine, the fetus is examined in the prenatal period for evidence of urinary tract dysfunction, but this is not yet common practice in equine medicine. As a result, urinary tract anomalies are diagnosed after birth using a wide variety of diagnostic modalities.

Investigation of the molecular detection of vaccine-derived equine herpesvirus type 1 in blood and nasal secretions from horses following intramuscular vaccination.

The objective of this study was to investigate whether intramuscular vaccination of healthy adult horses with a killed or a modified live equine herpesvirus type 1 (EHV-1) vaccine could induce transient positive PCR results in either blood or secretions collected on a nasopharyngeal swab. Four horses in each group received either a single killed or a modified-live vaccine intramuscularly. Two local commingled and 2 distant nonvaccinated controls were included for each group. All horses were observed daily for evidence of clinical abnormalities throughout the study periods. Blood and nasopharyngeal swabs were collected twice before vaccination and once weekly for 4 weeks after vaccination and submitted for PCR testing for EHV-1 by 2 independent laboratories using different real-time PCR methodologies. Serum samples collected from all horses on the vaccination day and 21 days later were tested for antibodies against EHV-1 using a serum neutralization test. Whereas the 2 vaccine strains tested positive in both EHV-1 PCR assays, nasopharyngeal swabs and whole blood collected from vaccinated and control horses had negative PCR test results for EHV-1 during the entire study period. Serum neutralization testing revealed a 2- to 4-fold increase in titers for all vaccinated horses, whereas titers in control horses were largely unchanged. The use of seropositive horses before immunization and the sampling frequency of 7 days may have prevented the occasional molecular detection of the vaccine virus in whole blood and nasopharyngeal secretions. However, the study results demonstrate that detection of EHV-1 DNA by PCR in vaccinated and unvaccinated healthy horses is not a common event.