Rabbit hole

VIN News Service art by Tamara Rees
Inspired by Adobe Stock/Marina Ziochin/Jackie Niam

Dr. Mara Varvil was almost ready by late spring. The veterinarian had completed a residency in clinical pathology, studied for months for the board certification exam and booked a hotel room for Aug. 17 at the testing center in Tampa, Florida. She knew the ongoing COVID-19 pandemic could ruin that plan, but there was a backup testing date in November. The testing center promised to inform her by June 15 if the date was changed.

Checking her email the morning of June 10, Varvil found a gut-wrenching message — not from the testing center, but from the hotel, canceling her room. Upon calling the hotel, she was informed that the test, too, had been canceled.

Another bombshell message came later that morning: The November backup date was axed, as well. The test would not be administered at all during 2020. It had been moved to August 2021. Soon after, Varvil received another email, this time from the testing center, apologizing to those who'd learned about the cancellation via hotel staff.

Varvil had planned, once she finished the boards, to begin a doctoral program in comparative pathobiology, which involves taking a PhD preliminary exam. The extended delay on her board exam was more than merely inconvenient. It made a practical mess.

"I can't study for both at the same time," she lamented.

Like many other students, Varvil is on the receiving end of a slew of testing cancellations that have left many in an extended limbo, whether in veterinary medicine or other professions, such as human medicine and law. 

The consequences reverberate. Unable to become certified, aspiring specialists in veterinary medicine are finding it difficult to land jobs or stay on track in their academic programs in the middle of already complicated hiring and education environments. It's another example of the myriad ways that the COVID-19 pandemic has upended lives and demanded flexibility, patience and resourcefulness.

Dr. Jessica Hanlon, who planned to take board examinations in August on the way to becoming an anatomic pathologist, coped with the testing delay by working as an emergency clinician during the summer.

She had searched for a job in pathology, but many referral practices had temporarily closed, imposed hiring freezes and/or reduced their caseloads. Emergency hospitals, though, have remained busy throughout the pandemic, to the point of being short-staffed. 

"I don't think I would have necessarily done emergency work if there hadn't been the testing delay," Hanlon said, noting that she was grateful for the opportunity and believes the unplanned experience was worthwhile. "I think overall, the emergency work will benefit me in the long run," she said.

"No one could have obviously predicted the COVID pandemic, and it wasn’t safe to have exams, so it's an unfortunate circumstance," she added. "But I think we’re just all kind of working through it the best that we can."

Hanlon continued to search for a job in pathology. In September, she landed a position at Antech Diagnostics. Like Varvil, Hanlon plans to take the pathology certification test next August.

For 2021, an 'ironclad yes'

For Varvil, the delay was made more disheartening by the lack of clear communication from the testing organization. The American College of Veterinary Pathologists (ACVP), which partners with a testing center in Tampa to oversee the board examinations, sent her multiple emails prior to June 15 that gave little indication that the test might be canceled, apart from the backup plan to reschedule for November.

"In my opinion, it was pretty poorly handled— just the order of how things happened and how we found out," she said.

Dr. Mark Ackermann, ACVP board president, told VIN News that the organization "just tried our best. We're not perfect," he acknowledged, noting that it was a difficult time and a hard decision. "We were trying our hardest to maintain [good communication]."

After rescheduling the exam to next year, the ACVP announced that the 2021 test would be conducted remotely.

Ackermann explained that organization lacked the time to prepare a remote exam for 2020, and that it opted to make the 2021 test remote in order to provide an "ironclad yes" to candidates that the test will happen.

One possible consequence of going remote is that the exam will not be quite what candidates have prepared for. Typically, they evaluate microscope slides and clinical chemistry cases as part of the examination; in the remote exam, multiple-choice questions will replace hands-on sections.

"That means that everybody that has studied for this year's test has not studied appropriately for next year's test," Varvil said. "No one's taken this test before, so we don't really know what we're looking for anymore."

Ackermann said the remote exam will differ in delivery but be the same in content and components, hitting all the required topics and areas that the test has always encompassed.

Changes across the board(s)

Specialty certifications and qualifying exams everywhere have experienced delays, if not cancellations.

The test that all U.S. veterinary school graduates must pass to qualify for licensing normally is administered for a few weeks in the spring and the fall. This year, the testing period for the North American Veterinary Licensing Examination (NAVLE) ended up being stretched over many months.

Heather Case, CEO of the International Council for Veterinary Assessment (ICVA), which oversees administration of the NAVLE, said the April two-week testing window was extended to more than five months, as testing sites began to close that month. The November testing window was extended from four weeks to four months.

Prometric, the company that administers the test, has reopened many of its sites but limits the number of participants in each session to keep them socially distant in order to reduce the risk of virus transmission.

Case said Prometric was responsible for the ultimate decision on when to open or close testing sites. Both Prometric and ICVA kept participants informed via website postings and emailed announcements as events unfolded, she said.

In an email interview with the VIN News Service, Case expressed thanks to NAVLE participants for their patience. "Almost all of the people with whom we have corresponded during this tumultuous time understand that what they may be experiencing, although inconvenient and nerve-racking at times, is the result of an unprecedented global pandemic," she said. "… Looking at the results of the April-September 2020 NAVLE, we are impressed with how well so many NAVLE candidates did under these very unusual circumstances."

At the American College of Veterinary Radiology (ACVR), Executive Director Dr. Tod Drost said the Executive Council recognized during its biennial meeting in April that the tests it administers — preliminary exams and certifying exams — would likely be "in jeopardy" because of the pandemic. By summer, realizing that travel had become difficult, the council decided to reschedule the certifying exam.

The preliminary exams, though, went forward in August as originally scheduled. They were offered at each residency site instead of in person at a single centralized testing site in Las Vegas.

The certifying exam consists of image interpretation, which requires a secure, standardized computer setup. Normally given in August, it was postponed to early December. The ACVR shipped computers to each host institution so that all candidates could take the test on the same type of secure equipment.

Drost noted that the ACVR always rents computers for the test site in Las Vegas, so shipping was the only added cost borne by the organization. Candidates, for their part, saved money on not having to travel to Las Vegas, he noted.

The ACVR anticipates returning to the original exam format after 2020, Drost said, but the organization will consider conducting an exam like this year's again if necessary.

Tests administered remotely this year have been supported by technological innovations. For example, the American Board of Veterinary Practitioners (ABVP) examination chair, Dr. Mike Dutton, said that the organization's certifying exam took place remotely in October with the use of webcam-based proctors provided by a third-party virtual proctoring company, as well as artificial intelligence screening that flagged any suspicious activity to be checked later via video.

Dutton said students experienced some technical issues with internet connection breaks, but everyone was able to take the test. Out of 50 test-takers, he said, two appealed their scores based on internet connection problems. Overall, he said, the test went well.

ABVP transitioned to an online credential submission format more than a decade ago, and switched the exam to a computer-based administration three years ago, which Dutton said made it easier to adapt to remote testing.

He noted that the 2020 exam was given in four two-hour blocks instead of the usual two four-hour blocks to allow people more opportunities to stretch their legs.

Dutton and the ABVP exam board began looking into possibilities for this year's exam in May and communicated with candidates via email as soon as they decided in August to offer the multiple-choice exam at home. They'll decide next May how to handle the 2021 exam.

As an indication of the sensitivity of the subject, two veterinary specialty organizations contacted by the VIN News Service — the American Veterinary Dental College (AVDC) and the American Board of Veterinary Opthalmology (ABVO) — declined to comment for this article.

The AVDC website shows that it canceled its 2020 Phase II certification examination and is having 2020 and 2021 candidates take the exam next June.

The ABVO offered the image-recognition and multiple-choice sections of its exam online, but is still searching for an alternative date and site for its practical portion, originally scheduled for December, according to its website.

The website of the American College of Veterinary Surgeons (ACVS) shows it rescheduled its Phase I examination from April 2020 to April 2021. The Phase II exam is scheduled for February 2021 but is subject to change because of COVID-19. Representatives of the ACVS could not be reached for comment.

Making peace with disruption

Rather than try to study for her PhD preliminary exam and clinical pathology boards at the same time, Varvil is postponing the doctoral program exam. She has to take the test at least one year before she defends her thesis. Varvil figures the doctorate program in comparative pathobiology that she's enrolled in now, which she intended to finish in three years, will take 3½ to four years to complete. While she is upset about the delay, she’s made peace with it.

"It’s been frustrating, but at this point, you kind of have to just deal with it how you can and keep moving, because there’s nothing I can do about it. There’s nothing that I can change to make it be any different," Varvil said. "I just gotta deal with it — deal with the hand that’s given."