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COE seeks veterinarian input on accreditation changes

Comparison: Does COE independence match that of accreditor for human medicine?


June 21, 2017
By: Jennifer Fiala
For The VIN News Service


The American Veterinary Medical Association Council on Education wants the schools it accredits to provide greater debt counseling to students and thorough lessons on personal and business financial management. It also wants programs to report data on the education loans amassed by students along with new graduate earnings, attrition rates and test scores.

Those and other suggested mandates appear in the proposed revisions of the COE's accreditation standards 6, 9 and 11. The COE — the sole programmatic accrediting body for veterinary education in the United States and Canada — periodically reviews and revises three to four of its 11 accreditation standards on a cyclical basis and as a whole every four years.

Changes in standards 6, 9 and 11 were drafted in response to the harsh realities faced by many aspiring veterinarians and new graduates: high education debt coupled with comparatively low starting salaries; business and financial education deficits; and pressures often tied to juggling burdensome student loan payments, long hours and maintaining a work-life balance. Collectively, they reflect a proposal in 2016 by the Student American Veterinary Medical Association, which asked officials to amend the COE's current standards or create a new 12th standard that requires accredited programs to demonstrate that they're educating students about the long-term costs of earning a degree in veterinary medicine. The proposal also called on the COE to mandate that its accredited programs provide students with counseling services and resources that address their career development, well-being, personal finances, educational debt repayment options and business management.

COE chairman Dr. John Scamahorn explained the review and implementation process this way: "After receiving feedback on proposals, the COE reviews that information and makes a final determination on the changes. This would occur at the September 2017 meeting. Colleges would then have one year to come into compliance with any revisions."

As part of the newly proposed changes, U.S.-accredited programs must: 

  • Annually submit data on employment during the first year following graduation, including starting salaries and educational debt.
  • Include in the curriculum legal, economic and regulatory principles related to the delivery of professional services as well as personal and business financial management skills, including educational debt management.
  • Describe opportunities for students to study business management skills and financial literacy.
  • Demonstrate that students are aware of and have access to financial counseling, personal wellness coaching, financial aid and career planning services.
  • Demonstrate that students with educational loans have an understanding of their long-term financial obligations.
  • Provide a list of tuition-related information for prospective students, including estimated total educational costs and tuition increases over the previous decade.
  • Demonstrate that individuals who provide personal psychiatric or psychological counseling for students have no involvement in their academic assessment.

Stakeholders are invited to offer input on the revisions by June 30. Comments can be submitted to AVMA Administrative Assistant Millie Maresh at mmaresh@avma.org or mailed to her attention at AVMA offices, 1931 N. Meacham Road. Ste 100, Schaumburg, IL 60173-4360.

Diversity addition

The COE reportedly received mostly supportive comments ahead of the group's decision in March to add diversity language to standard 7, which concerns the admission processes of accredited veterinary colleges. It now reads, in part: "The college must demonstrate its commitment to diversity and inclusion through its recruitment and admissions processes, as consistent with applicable law. The college's admissions policies must be nondiscriminatory, as consistent with applicable law."

AVMA officials relayed in a June 2 blog post that the COE's intention is not to require that colleges admit specific numbers of underrepresented minorities. Rather, the mandate is designed to "promote the recruitment and retention of a diverse academic community."

"The council believes that a college that fosters a climate of diversity and inclusion will have a rich learning and social environment that promotes the development of graduates prepared to deliver a broad array of veterinary services to a diverse population," AVMA officials stated.

Along with the diversity change, the COE modified standard 11 (outcomes assessment) to more broadly define communication skills and changed standard 1 (organization) to clarify the importance of professional development in learning theory and instructional practices.

Changes follow unrest

The COE's call for public comments is said to reflect the accrediting body's intent to become more transparent and inclusive. Five years after critics branded the COE as unduly influenced by the politics of its parent, the AVMA, efforts have been made to comply with government-ordered changes to distance the two entities and mend the accrediting body's rift with veterinarians.

Or so say officials with the COE and AVMA.

The COE is scheduled for review in early 2018 by the National Advisory Committee on Institutional Quality and Integrity, an advisory body to the U.S. Secretary of Education on matters of accreditation of higher-education institutions. Organizations that confer accreditation periodically must renew their authority to do so. The COE is on a five-year review cycle.

The reviews went smoothly for decades, until 2012, when the AVMA had difficulty renewing the COE's status. Friction between the COE and disgruntled veterinarians prompted hundreds to petition NACIQI to withhold continued recognition. Critics asserted that the COE lacked transparency, operated amid conflicts of interest and failed to uniformly apply its achievement standards.

The COE eventually received NACIQI's nod, earning re-recognition last year, but not before undergoing an operational facelift. Central to the COE remodel — under way since 2015 — is the expanded involvement of the Association of American Veterinary Medical Colleges (AAVMC), which now has a bigger seat at the accrediting body's table by providing financial support in addition to selecting members.

Today's COE, AVMA officials contend, functions autonomously, much like the Liaison Committee on Medical Education (LCME), the U.S. programmatic accreditor for programs that lead to a Doctor of Medicine, or MD, degree. The accrediting body is jointly supported by the American Medical Association (AMA) and Association of American Medical Colleges (AAMC).

The firewall between the AVMA and COE is now "on par" with those in place to ensure the autonomy of the LCME, officials state. In response to pressure from USDE and the profession, AVMA Executive Board members no longer are allowed on accreditation site visits. The COE removed its AVMA liaison, a non-voting member who used to sit in on all accreditation meetings, and hired its own attorney, no longer sharing the AVMA's legal counsel. What's more, those who select COE committee members cannot be serving on the AVMA Board of Directors or House of Delegates.

"The big thing of COE, we're an autonomous authority," the COE's Scamahorn insisted last August, speaking before AVMA members in San Antonio, Texas. "We can, one, examine the programs and evaluate them. We make our decisions without anybody's input with that and then we assign a classification."

The AVMA's ownership of the COE, however, is ubiquitous. The COE might have its own attorney, critics say, but the AVMA Board of Directors had to approve the allocation and pay for it. The COE's budget is buried within the AVMA's $35 million-plus annual spending plan. Details concerning accreditation revenues, expenditures and any support provided by AAVMC and AVMA are not public.

The LCME's budget is similarly intertwined with its sponsors. "The AAMC and AMA split evenly their financial support of the LCME," explained John Buarotti, AAMC media relations specialist. "The LCME does not have its own operating budget. ... The sponsoring organizations support the operations of the LCME and the LCME Secretariat."

Even so, the LCME appears to have more administrative autonomy than the COE. For example, the LCME has its own website and domain name while the COE's online presence is a page on the AVMA's website. USDE's online directory of nationally recognized accreditors lists Dr. Karen Martens Brandt, director of the AVMA Education and Research Division, as the contact for the "American Veterinary Medical Association Council on Education." By comparison, the listing for LCME makes no reference to the AMA or AAMC. Barbara Barzansky, an LCME co-secretary, is the organization's contact.

Dr. Robert Marshak, dean emeritus of the University of Pennsylvania School of Veterinary Medicine, is among those who want to see more distance between the COE and AVMA. He shared his perspective in a recent letter to the VIN News Service, which appears by clicking on the above letter icon. The COE Executive Committee addressed his concerns in a response that follows.

Makeup

To determine whether the COE and LCME function similarly, VIN News compared the makeup, financing and professional scope of both organizations.

The LCME's 19-member body consists of representatives from a variety of professional areas who are nominated for appointment by both parent organizations. The AMA Council on Medical Education (a 12-member body elected by the AMA House of Delegates and the Medical Student Section Governing Council) and the AAMC each nominate eight candidates — seven professionals and one student member — for membership to the LCME. The LCME chooses two public members and a member to represent the Committee on Accreditation of Canadian Medical Schools (CACMS). Most volunteers on the LCME serve three-year, once renewable terms.

The COE's 20-member body is comprised of representatives from a variety of professional and academic areas. Eight volunteers are named by the AVMA COE Selection Committee, a five-member body appointed by the AVMA Board of Directors. Another eight volunteers come from the AAVMC COE Selection Committee, a five-member body comprised of the AAVMC past president and four appointees of the Board of Directors. The Canadian Veterinary Medical Association selects one volunteer, and the COE appoints three public members. All members are appointed for six-year terms except the official AAVMC and CVMA representatives who serve three-year terms, renewable once.

Sponsorship and staff

The LCME is supported jointly by the AMA and the AAMC, and costs related to accreditation are evenly split between the two sponsors. The AAMC and the AMA each appoint two LCME co-secretaries and assistant secretaries (known jointly as the Secretariat) who maintain offices at the headquarters of their sponsoring organizations in Washington, D.C. and Chicago, respectively.

The COE is supported jointly by the AVMA and AAVMC, however the AVMA is the accrediting body's primary sponsor. The COE is staffed by the AVMA Education and Research Division, directed by Dr. Karen Brandt, with help from AAVMC Senior Accreditation Advisor Dr. Sheila Allen. The COE meets at AVMA headquarters in Schaumburg, Illinois.

Scope

The LCME is identified by USDE as the sole programmatic accreditor of medical education leading to the MD degree. To date, the LCME has extended accreditation to 147 programs in the United States and Puerto Rico. The LCME accredits 17 programs in Canada, working jointly with the CACMS.

No U.S. program has opened without receiving LCME candidacy status, a first step in the accreditation process. In general, fully accredited LCME programs are re-evaluated every eight years.

The COE is identified by the USDE as the sole programmatic accreditor of veterinary education in the United States and Canada. The COE also accredits programs outside the United States. To date, the COE has extended accreditation to 30 U.S. programs; five in Canada; and 14 programs in the Caribbean, Mexico, Europe, New Zealand and Australia.

No U.S. program has opened without receiving the COE's reasonable assurance, a first step in the accreditation process. In general, fully accredited COE programs are re-evaluated every seven years.

Authority

The LCME's accreditation of U.S. programs establishes their eligibility for selected federal grants and programs, including Title VII funding administered by the U.S. Public Health Service. Most state boards of licensure require that U.S. medical schools granting the MD degree be accredited by the LCME as a condition for licensure of their graduates. Eligibility of U.S. students in MD-granting schools to take the United States Medical Licensing Examination requires LCME accreditation of their school. Graduates of LCME-accredited schools are eligible for residency programs accredited by the Accreditation Council for Graduate Medical Education. No U.S. program has opened without receiving the LCME's candidacy status, a first step in the accreditation process.

The COE's accreditation of U.S. programs establishes their eligibility for selected federal grants and programs, including Title VII funding administered by the U.S. Public Health Service. All state boards of licensure require that U.S. veterinary schools granting the DVM or VMD degree be accredited by the COE as a condition for licensure of their graduates. Eligibility of students in DVM- or VMD-granting schools to take the North American Veterinary Licensing Examination requires COE accreditation of their school or they first must complete an equivalency program. No U.S. program has opened without receiving the COE's reasonable assurance, a first step in the accreditation process.

Public access

Deliberations concerning specific MD programs are confidential. The LCME's accreditation processes and associated documents are available to the public, and the accreditation status of each accredited program is listed on the organization's website. Each school's individual accreditation report, however, belongs to that school; the LCME holds each school's report in strict confidentiality.

Deliberations concerning specific veterinary medical programs are confidential. The COE's accreditation processes and associated documents are available to the public, and the accreditation status of each accredited program is listed on the organization's website. Each school's individual accreditation report, however, belongs to that school; the COE holds each school's report in strict confidentiality.




VIN News Service commentaries are opinion pieces presenting insights, personal experiences and/or perspectives on topical issues by members of the veterinary community. To submit a commentary for consideration, email news@vin.com.



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