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

Must pass all sections
Administered at multiple ECFVG-approved
sites according to Manual of Administration
 Also administered by the Canadian National
Examining Board (NEB)

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

ECFVG Program Steps
®
1.
2.
3.
4.
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)
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

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.
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
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
CPE History
®
Experts selected most pertinent skills to
evaluate performance competency
 Scoring process defined
 Goal is to separate “masters” from “nonmasters”
 Interested in evaluating for minimal
competency

Performance Benchmarks
®

Consider the behaviors to be observed and
what constitutes minimal levels of
performance at each CPE scoring level:
Superior
 Good
 Satisfactory
 Unsatisfactory

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
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

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

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
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

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

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

Surgery Competencies
®
 Prepare
the patient
 Prepare self
 Perform surgical procedure
Surgical Skills
®
 Asepsis
 Ovariohysterectomy technique
 Tissue trauma
 Hemostasis
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

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
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.

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
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?”
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
Additional Information
®
 ECFVG
Web site
 www.avma.org/education/ecfvg/default.asp
 Contact
ECFVG office
 ECFVG@avma.org
 800-248-2862,
ext 6675