Competency-Based Veterinary Education (CBVE)
Competency-based veterinary education is an approach modeled after competency-based medical education and is designed to prepare graduates for professional careers by confirming their ability to meet the needs of animals and the expectations of society. This approach focuses on outcomes-based and learner-centered education and assessment. This website provides resources on the CBVE framework, Entrustable Professional Activities and Milestones. Additional work products will be added as they become available.
The AAVMC CBVE Working Group was created and charged with developing a modern competency framework for veterinary education and clinical assessment in July 2015. The group began by systematically analyzing the most contemporary work in competency-based education undertaken in health professions like human medicine. The result of their labor represents one of the most substantial pedagogical projects ever undertaken by the AAVMC. We invite our colleges and schools to embrace this framework as a tool to use in any way they see fit, whether they are in the process of refining or completely redesigning their professional curricula.
Membership and Co-chairs: The CBVE Working group includes representatives from veterinary colleges and schools across the U.S., Canada, Europe, the U.K. and some with experience from Australia.
Co-chairs: Kristin Chaney (Texas A&M University) and Jennie Hodgson (Virginia Tech) Members: Harold Bok (Utrecht University), Dr. Jared Danielson (Iowa State University), Jan Ilkiw (University of California – Davis), Susan Matthew (Washington State University), Stephen May (Royal Veterinary College), Emma Read (University of Calgary), Bonnie Rush (Kansas State University), Kathy Salisbury (Purdue University)
Advisors: Jody Frost, Ted Mashima
An ongoing process of gathering information about a learner’s knowledge, skills, and /or behavior (ACGME, 2013).
A way of thinking and feeling about something/someone that is based on values, education, experience, and typically reflected in behavior.
The array of abilities (knowledge, skills, and attitudes) across multiple domains or aspects of performance in a certain context. Statements about competence require descriptive qualifiers to define the relevant abilities, context, and stage of training. Competence is multi-dimensional and dynamic. It changes with time, experience, and setting (Frank et al., 2010).
An observable ability of a health professional related to a specific activity that integrates knowledge, skills, values, and attitudes. Since competencies are observable, they can be measured and assessed to ensure their acquisition (Frank et al., 2010).
Competency-Based Veterinary Education
An outcomes-based approach to the design, implementation, assessment, and evaluation of veterinary programs, using an organized framework of competencies (as adapted Frank et al., 2010).
An organized and structured representation of a set of interrelated and purposeful competencies (Willet, 2012).
The minimum required abilities in all domains in a certain context at a defined stage of veterinary education, training, or practice (Frank et al., 2010).
Day One Competencies
Competencies required at the time of graduation, synonymous with “entry-level competencies” (Welsh et al., 2009).
Domains of Competence (DOC)
Broad distinguishable areas of competence that together constitute a general descriptive framework for a profession (Englander et al., 2013).
Entrustable Professional Activity (EPA)
An essential task of a discipline that a learner can be trusted to perform with limited supervision in a given context respecting regulatory requirements, once sufficient competence has been demonstrated (as adapted from Englander et al., 2017).
The systematic collection and analysis of information related to the design, implementation, and outcomes of a program, for the purpose of monitoring and improving the quality and effectiveness of the program
Assessment of a student with the primary purpose of providing feedback for improvement as well as to reinforce skills and behaviors that meet established criteria and standards without passing a judgment in the form of a permanently recorded grade or score (ACGME, 2013).
Lacking the required abilities to carry out a context-specific task at the predetermined performance level for a defined stage of veterinary education, training, or practice (Englander et al., 2017).
A defined, observable marker of an individual’s ability along a developmental continuum (Englander et al., 2017).
Represents the intended results or consequences of instruction, curricula, programs or activities. Describes the goals and intentions of the instructor in teaching the course or learning activity. Focuses on the content and skill of the course or learning activity.
States what a learner can specifically “do” at the end of a learning session or program. Represents the achieved results or consequences of what has been learned.
A specific task or activity that can be performed by individuals (practitioners/learners) as a result of training, experience or practice; skills may be categorized as technical/clinical and nontechnical/professional skills.
To better describe each competency, illustrative subcompetencies are provided as examples of content that may be modified or refined by individual schools. Subcompetencies are more granular than competencies and can be used to develop course or rotation objectives and assessments.
Assessment with the primary purpose of establishing whether or not performance measured at a single defined point in time meets established performance standards, permanently recorded in the form of a grade or score (ACGME, 2013).
A set of principles or standards of behavior that reflect what an individual believes is important in life, and influences their choices and behaviors.
The CBVE framework consists of nine domains of competence, each representing a group of related abilities necessary for veterinary graduates. Associated with each domain is a list of competencies, all of which are considered core for veterinary education. The CBVE framework consists of 32 competencies, some of which lend themselves to assessment in the clinical context, while others may be best assessed in the pre-clinical curriculum. To better describe each competency, illustrative subcompetencies are provided as examples of content that may be modified or refined by individual schools. Subcompetencies are more granular than competencies and can be used to develop course or rotation objectives and assessments.
Entrustable Professional Activities (EPAs)
The practice of veterinary medicine requires more than the ability to demonstrate independent competencies. It necessitates simultaneous integration of multiple competencies to allow veterinary professionals to perform day-to-day activities in the workplace.
For an early stage professional, developing their capability, units of activity can be defined as Entrustable Professional Activities (EPAs). EPAs provide the groundwork for the future development of assessment tools and a structure to provide feedback that guides learners as they work towards independent practice (via use of milestones). In this way, EPAs provide the link between competencies and the professional workplace.
In this document, the AAVMC CBVE Working Group has identified eight core EPAs for veterinary education and outlined the relationship between each EPA and its associated domains and competencies. Colleges and schools may wish to create additional EPAs for their unique contexts.
Milestones will be used to assess learner achievement in specific competencies within the context of an EPA (Entrustable Professional Activity). Each EPA can be mapped to five to seven competencies that are critical to making an entrustment decision. Each competency has four levels of learner milestones (novice, advanced beginner, competent, and proficient) that represent a range of observable/expected behaviors with increasing skill and efficiency. While EPAs provide clinical context for specific competencies, milestones provide a structure to assess learner achievement for each competency within the EPA.
Each level of milestone (e.g. advanced beginner) represents an anchor on a continuum of learner competence from novice to proficient. Additional support will be provided through clinical vignettes that further illustrate observable learner behaviors to assist faculty in consistent assessment of trainees. The CBVE Working Group has developed four levels of milestones (novice, advanced beginner, competent, and proficient) for each of the 32 competencies of the CBVE framework.
1. Where is my discipline (e.g., epidemiology, physiology, radiology)?
In the CBVE framework, domains of competence are inclusive of foundation/basic sciences. Individual subject matter is not outlined specifically as it is expected to be included in higher level thinking (i.e., outcomes for a veterinary graduate). For example, a student that is competent in “CBVE competency 1.1 – Gathering and assimilating relevant information about animals” should be expected to perform and interpret results from the physical examination, which requires a working knowledge of physiology, anatomy, infectious disease, etc.
Specific skills such as intravenous catheterization or post-mortem/necropsy examination, for example, are not specifically listed in the CBVE competencies. The CBVE competencies are overarching and many of the specific technical skills can be found within those competencies. For example, a student that is competent in “CBVE competency 2.1 – Performs veterinary procedures and post-procedural care” must be able to perform many technical skills.
3. Why does this framework focus on clinical graduate outcomes rather than public health, research, and other non-clinical career paths?
The CBVE framework outlines “clinical reasoning and decision making” in domain of competence 1, as a representation of the skills necessary to “think critically” in any aspect of the veterinary profession. No matter the career choice, “synthesizing and prioritizing problems” (CBVE competency 1.2) is an important aspect of the healthcare professions. Veterinary education maintains its foundation in the care for animals with more specific career pathways to be defined based upon regional and societal needs or foci of individual programs.
4. How does this framework relate to the COE nine clinical competencies?
The CBVE framework is based upon a variety of resources, including the nine clinical competencies established by the Council on Education (COE).
5. Within the new framework, where are public health and One Health?
The CBVE framework is considered core for all students in all schools and developed to be achievable by all schools. Its design reflects the clinical professional degree and the competencies that are common across schools rather than outcomes that may be taught at a specific school given each school’s unique mission and philosophy. In the CBVE framework, domain of competence 4 is dedicated to public health: “The graduate responds to issues at the interface of animals, humans, and the environment, utilizing a global perspective and sensitivity to local cultures.” One Health fits well within the scope of this domain as outlined in CBVE competency 4.2 – Promotes the health and safety of people and the environment.
6. Where are difficult decisions included (e.g., end of life, finances, etc.)?
Domain 5 Communication states “the graduate communicates effectively with diverse clients, colleagues, other healthcare professionals and the public to promote animal, human and environmental health and wellbeing” and CBVE competency 5.2 states the graduate will “demonstrate client-centered communication.” There are subcompetencies listed in this domain that exemplify end-of-life discussions and this would be where other difficult discussions would be developed by individual programs.
7. Why are all EPAs clinical?
Entrustable Professional Activities (EPAs) are designed to represent core activities veterinary professionals will encounter at entry-level in the workplace, and are distinct from simulations in the practical laboratory or classroom. Colleges and schools may wish to create additional EPAs for their unique contexts and that are focused on additional workplace-based activities.
8. How would a school implement EPAs? Is this one big exam?
Based upon the medical education literature, EPAs are performed in the clinical setting across a rotation/service experience. For veterinary education, EPAs are predominantly performed as students rotate through various clinical experiences. An EPA in itself is not an assessment, but rather provides the foundation for the development of assessment rubrics because it describes activities in the workplace. EPAs are also useful to provide feedback and insight into students’ performance.
9. How do EPAs relate to OSCEs?
Objective, structured, clinical examinations (OSCEs) are timed units of assessment most commonly performed through models, simulation, and/or case-based experience in the curriculum. An EPA represents a workplace-based activity and provides a foundation for the development of workplace-based assessment. EPAs may be performed during the final year of the veterinary program over a period of time (e.g., within a clinical service rotation and across multiple rotations).
10. How would schools address the challenge of students performing EPAs in clinics with limited primary case responsibility?
For some of the EPAs, students will require a clinical service where hands-on and primary case responsibility is possible. For other EPAs, performance may require more direct faculty supervision.