By: Kristin P. Chaney (@ChaneyDvm)
As the interest in CBE continues to grow within the interprofessional space, so does the challenge of maintaining fidelity of the model. With more and more programs beginning to implement outcomes-based education, it becomes critical to ground the process in accurate and shared terminology. Selecting the most appropriate component of CBE (i.e., competencies, milestones, or EPAs) for the learning context helps ensure accurate use of terminology and promotes fidelity. Ensuring the accurate use of CBE terminology is key when designing curriculum, developing assessment opportunities that support learner progression, and providing clarity of the model during faculty development.
In 2018, the Competency-based Veterinary Education (CBVE) Model was published and since that time, veterinary programs worldwide have begun the transition to outcomes-based education to improve new graduate success and patient outcomes. In veterinary education, graduates must be ready to enter professional careers in general practice at the time of graduation. Post-graduation education is reserved for those that desire specialization/board-certification in specific disciplines (e.g., diagnostic imaging, dermatology, internal medicine, etc.), but is not required for entry-level practice. The idea of providing an outcomes-based model, that could support veterinary training across international programs, offers great opportunities for academicians and educators to share learning experiences and assessments all linked to the shared competency framework.
While there are many veterinary academicians familiar with medical education and the competencies, milestones, and EPAs associated with CBME, the veterinary educators with less familiarity with CBME have greater risk of misinterpreting or misusing terminology during implementation, increasing the risk of failure or perceived failure of the model. It is important to note that in veterinary education, phases of implementation vary. There are some programs implementing individual aspects of CBVE (e.g., the implementation of use of entrustment-supervision scales with EPAs in clinical training) while other programs are approaching a more comprehensive curriculum redesign using the CBVE Competency Framework for curriculum mapping and backwards course design of the revised curriculum. No matter the starting point, learning a new pedagogical model requires grappling with new concepts, new vocabulary, and new methods for deployment across the educational program. Creating a strong foundation on which to scaffold the new model requires knowledge and adherence to accurate terminology as a critical step in ensuring fidelity of the new educational model.
One mechanism to promote accurate use of terminology requires focusing on the context in which learning occurs. Whether the setting is in the preclinical skills laboratory or on a clinical rotation, correct application of terminology allows consistency across programs. As an example, within the CBVE Competency Framework, we recognize outcomes are expressed as “competencies”, which are meant to be achieved by the time of graduation, yet outcomes are expressed as “milestones” when describing the stages of learner development for an individual competency across the curriculum. Use of milestones is helpful for identifying areas of growth for individual learners and in supporting decisions for learner progression. Here’s a specific example related to veterinary education: consider CBVE Competency 1.1 “Gathers and assimilates relevant information about animals” which students must achieve by the time of graduation. When the milestones for Competency 1.1 are reviewed, the narrative descriptions describing the expected learner progression for this competency across the program are illuminated (e.g., a novice learner may perform an incomplete or disorganized exam and may overlook key findings, and with additional training and experience, the competent learner performs a systematic exam and documents most abnormal findings).
It is important to recognize that terminology changes again when learners are required to demonstrate multiple competencies while performing an authentic workplace-based activity. The CBVE EPAs represent entry-level veterinary work and are intended to be performed during the clinical phase of training. Use of accurate terminology surrounding the 8 published EPAs has been inconsistent since their introduction into veterinary education. The confusion primarily centers around what encompasses this type of activity and when/where the activity should be performed. As EPAs represent entry-level work of veterinarians, they are meant to be performed in the clinical workplace. The same or similar activity should not be called an EPA if being performed outside the workplace-based environment (e.g., simulated in a lab) because it fails to meet all the criteria of an EPA. The significance of the term “entrustment” and subsequent usefulness of EPAs in making decisions about how readily a learner can be provided case responsibility is diminished when EPA terminology is misused in preclinical training. For example, consider CBVE EPA 7 “Perform general anesthesia and recovery of a stable patient including monitoring and support.” When this activity is performed in a clinical environment on an actual veterinary patient and evaluated using an entrustment-supervision scale, this is an EPA. However, if this activity were instead performed in a clinical skills lab or preclinical surgery course where the case circumstance is controlled or where a simulator model is used, then the activity would be a subcompetency under CBVE Competency 2.1 “Performs veterinary procedures and post-procedural care.” Simulated activities omit the “contextual” or “situational” complexities that learners must navigate in the clinical environment preventing educators from assigning a level of entrustment for independent work based upon observation of the learner’s performance of the activity in the clinical context. Veterinary students need experience with assuming full responsibility for providing appropriate care to patients to develop their confidence, competence, and autonomy. Clearly, the importance of both opportunities for performance cannot be understated and the distinction in terminology is critical.
As CBE continues to receive worldwide recognition in the healthcare professions, the need to ensure fidelity through use of accurate application of terminology improves successful implementation. In veterinary education, the development of the CBVE Model offers a platform for sharing competencies and assessment tools to support new graduate success and patient outcomes. This represents an unprecedented opportunity for educational programs across the globe to share educational data and experiential learning opportunities as a mechanism for advancement of veterinary education.
For more information on CBVE, please visit our website at http://cbve.org
About the author: Kristin P. Chaney, DVM, Diplomate ACVIM (LAIM), Diplomate ACVECC, is a Clinical Associate Professor and Assistant Dean for Curriculum and Assessment in the School of Veterinary Medicine & Biomedical Sciences at Texas A&M University, in College Station, TX. Her research in veterinary education focuses on curriculum development and novel educational modalities. She is co-chair of the American Association of Veterinary Medical Colleges (AAVMC) Council on Outcomes-based Veterinary Education.
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