Federal panel continues recognition of veterinary accreditation process

A panel of the U.S. Department of Education voted Dec. 11 to continue recognition of the American Veterinary Medical Association Council on Education (AVMA-COE) as the accrediting agency for veterinary schools. However, the National Advisory Committee on Institutional Quality and Integrity (NACIQI) also voted to require the COE to address issues that remain unresolved since they were cited in a 2012 review, recommending a deadline of six months to one year to come into compliance.

Controversy stems from what critics say are looser standards of accreditation for foreign schools and from COE acceptance of distributive education, in which students receive clinical experience at community veterinary practices instead of a university teaching hospital.

Critics also claim the agency is unduly influenced by its sponsor, the AVMA, with some recommending a new body to accredit veterinary schools.

Written comments oppose COE

Of more than 1,000 written comments submitted to the committee on whether the government should continue to recognize the COE, more than 900 expressed opposition, leading to NACIQI staff concerns that the COE is not widely accepted by its stakeholders, as required in federal regulations.

According to the Department of Education staff report prepared for the NACIQI meeting, the commenters' concerns allege:

> “Standards are vague, inconsistently enforced, and deliberately ‘weakened' to justify, retrospectively, the accreditation of substandard schools.”

> “There is undue political influence on the accreditation standards and policies of the agency” by the AVMA and the American Association of Veterinary Medical Colleges (AAVMC), which appoint COE members. The report cited complaints that the COE “acts at the whim of the professional association, whereby the interests of the professional members may be in direct conflict with the profession and the public good.”

> The accreditation of “substandard schools that lack a robust research enterprise, and inadequate supervision and clinical training of veterinary graduates.”

> The AVMA executive board “improperly” decided to accredit foreign veterinary schools although it is “strongly opposed by the veterinary community.”

The staff report notes that while the COE has revised its policies and practices since the 2012 review, it still has not demonstrated wide acceptance among veterinary educators and practitioners.

Addressing the NACIQI, COE Chairman Frederik J. Derksen attributed the controversy to “opinion leaders who don't like what we do.” The majority of AVMA members support accreditation of foreign schools, he said, citing a recent ballot in the association's House of Delegates in which 80 percent were favorable.

The COE, he said, takes care “to ensure standards are applied to all schools, regardless of location” and attributed some of the complaints to economics. A number of veterinarians think there are too many veterinarians in practice, “which depresses income,” he said.

The 14 accredited foreign schools “are the best … in the world. There are others that would like to be accredited but don't meet the standards,” Derksen said.

“By any measure that we use, [foreign schools'] outcomes are comparable to any schools in North America,” he said. Student attrition, job placement and professional examination pass rates are “the same” in foreign and U.S. schools.

Speakers split on recognition

Of the 19 commenters who spoke at the meeting, 10 voiced support for continued recognition of the COE as an accrediting body and nine were opposed. Speakers on both sides of the issue included:

Sheila W. Allen, DVM, MS, DACVS, dean of the College of Veterinary Medicine at the University of Georgia and a former member of the COE.

Allen said that since the 2012 report, which found noncompliance with Department of Education regulations in several areas, the agency has “carefully considered input from stakeholders.” In response, she said, “a number of positive changes have been made that improved our policies or procedures.”

One change has been in the way COE members are chosen, she said. Previously, decisions on membership were made by the AVMA. After the 2012 findings, the AVMA and AAVMC make appointments jointly.

Eric Bregman, VMD, past president of the New York State Veterinary Medical Society and chairman of the organization's committee on accreditation.

He said the panel should withhold recognition of the COE “until the quality and integrity of the accreditation process is ensured.”

“Standards have been broken and applied with astounding inconsistency,” Bregman said, with the result being “substandard schools.”

In response to a NACIQI member's request for evidence of inconsistency, Bregman said that “as a practitioner, it appears the standards are being continually massaged to meet the needs of the schools.”

He called for “some objective measure of whether the standards are being applied evenly and consistently.”

Bregman said the COE, sponsored and staffed by the AVMA, should have its own staff, budget and legal counsel, creating “an impenetrable firewall between the agency and its sponsoring organizations.”

Asked if a better alternative would be for the COE to seek more inclusion and make internal changes in its procedures, he said, “That's something I'd be receptive to and something I'd be willing to participate in.”

Nancy O. Brown, VMD, DACVS, DACVIM, owner of Hickory Veterinary Hospital in Pennsylvania.

Brown agreed with Bregman. “The COE has failed and should be separated from the AVMA and moved to an independent agency,” she told the committee.

Because AVMA and AAVMC both appoint COE members, they can influence the agency's deliberations, she said.

Instead, Brown suggested, the accrediting agency “should be placed in the hands of educators and others who believe in providing our passionate students a respected, healthy and profitable career.”

Trevor Ames, DVM, dean of the University of Minnesota's College of Veterinary Medicine and president of the AAVMC.

Ames said he was representing all 35 accredited veterinary colleges in the United States and Canada and 14 more in other countries in supporting the COE as a recognized accrediting agency.

“The present system is a standards-driven, evidence-based process,” he said. “The COE is constantly evolving to meet the needs of the medical veterinary profession.”

Cyril Clarke, PhD, dean of the Virginia-Maryland Regional College of Veterinary Medicine and a member of the COE.

Clarke said the negative comments are “intended to limit the veterinary workforce” and asked the committee to fully recognize the agency.

The COE's acceptance of distributive education as an alternative to on-campus clinical experience is an example of “new approaches to letting people learn in real-world situations,” he said.

Citing his college's recent accreditation evaluation, Clark said, “I can assure you that the … procedures were rigorously and fairly applied in an objective manner.

“I recommend that the COE be accorded full recognition,” he said. “The COE has demonstrated its ability to adapt to the changing needs of the public, the profession, as well as academia.”

Eden Myers, DVM, self-described as “the only general practitioner you're going to hear from today.”

Myers said she was one of the volunteers who created the web form for the veterinary public to submit negative comments about the COE to NACIQI. “We did not create the discontent those comments revealed to you. We simply enabled it all,” she said.

The chief issue, Myers said, is what she called “political entanglement” between the COE and the AVMA. “The agency is housed within the trade association. Both the trade association and the agency work diligently to stay separate, but they can't.”

Frank Walker, DVM, a North Dakota veterinarian, treasurer of the American Association of Veterinary State Boards and a former member of the COE.

Walker said that from his experience, the COE has not been responsive to its critics and does not have wide acceptance among its stakeholders.

“The process or system is broken,” he said. “The agency has not responded to engage third-party commenters, such as myself.”

Jeffrey Klausner, DVM, chief medical officer, Banfield Veterinary Hospital, a national chain of pet hospitals.

Klausner voiced support for the standards set by the COE.

“My role is to ensure the quality of the veterinary work done in over 900 hospitals and ensure the quality of our 3,000 veterinarians,” he told the committee. “We monitor everything that can be measured, from state board complaints to anesthetic deaths doctors have had” and Banfield has seen “no difference in competency and skills from one school to the next.”

The NACIQI recommendation, along with the Department of Education staff analysis, will be forwarded to U.S. Education Undersecretary Martha J. Kanter for a final decision on reaccreditation of the COE.

John T. Adams III is a freelance writer in the Washington, D.C., area.