Illustration by Jon Williams
The University of Arizona College of Veterinary Medicine's pursuit of full U.S. accreditation could be at risk in part because too many members of its first class have not passed a crucial test of their competency in entry-level clinical practice — the North American Veterinary Licensing Examination.
The college recently disclosed on its website that only 72% of its inaugural class passed the NAVLE before graduating in August. The school, which opened in 2020, needs a pass rate of 80% or better to receive full accreditation from the American Veterinary Medical Association Council on Education.
Veterinary school graduates may not be licensed in the U.S. or Canada without first passing the NAVLE. The college has an additional year to achieve an 80% pass rate, as the COE looks at data from two cohorts before considering exam scores, according to the program dean, Dr. Julie Funk. Fulfilling the outcomes assessment standard, one of 11 accreditation standards set by the COE, will hinge largely on whether a vast majority of the class of 2024 can pass the exam before graduating.
In addition to test scores, other aspects of the program require improvements. The COE voted last month to continue the school's provisional accreditation status through 2025 and cited deficiencies in five of the 11 standards required for accreditation.
The deficiencies noted were in clinical resources, students, faculty, curriculum and research (standards 4, 6, 8, 9 and 10, respectively), Funk said. "We have consulted with representatives from the AVMA COE, are confident that we can resolve the council's concerns, and we are on track for full accreditation by June 2025," she said by email. She did not elaborate on the improvements that are needed but added: "Continuation of provisional accreditation status is not an adverse action by the AVMA COE nor a setback to our pursuit of full accreditation."
Failure to meet all accreditation standards by the 2025 deadline could lead to adverse actions by the COE. UA is required to submit reports twice a year to the COE to mark the program's progress.
Under the provisional status, currently enrolled and future students who complete the program would be considered graduates of an accredited institution, according to the UA website.
New programs like UA's don't qualify for full accreditation until after their first class graduates, and provided that group passes the NAVLE in sufficient proportion. Under COE rules, a provisionally accredited program has five years to become fully accredited. The UA veterinary college is an accelerated program, designed to be completed in three years rather than the standard four.
The 2023 class was comprised of 106 students. Some failed the test twice before graduation.
Since their NAVLE scores were released in May, graduates have heard little to nothing from the university about the disappointing showing, according to a half-dozen members of the class of 2023 who were reached by the VIN News Service. Funk says graduates were told "that they continue to have access to multiple resources at the college to support them in preparing for the NAVLE."
The school appears to be concentrating on assisting prospective graduates who are sitting for the exam during the current academic year. For the 2024 class, Funk said the college has implemented "comprehensive student support" for the NAVLE that includes one-on-one time with learning specialists, access to practice exams and preparatory software, and a four-week review course built into the clinical year.
Funk noted that the program started the same year as the Covid-19 pandemic, in 2020. As was the case throughout higher education, the new veterinary college was compelled to pivot to online classes. She pointed out that UA isn't alone in its NAVLE performance challenges, which she attributed, at least in part, to the lingering effects of lockdowns and other restrictions associated with the early phases of the pandemic.
"Nationally, NAVLE scores have trended downward since 2021, and Covid certainly played a significant role for many programs," Funk said. "Our 2023 scores encapsulate the many complexities of a new college — particularly starting in 2020 at the height of the pandemic."
What the stats show
The International Council for Veterinary Assessment, which administers the NAVLE, reported that 86% of senior students from AVMA-accredited programs passed the NAVLE during the 2022-23 testing cycle. It was the third year in a row of declines: The pass rate was 95% in 2019-20. It dropped to 92% in 2020-21, and to 90% in 2021-22.
Letters
How much the pandemic is responsible for testing failures is unclear. Dr. Heather Case, chief executive of the ICVA, suggested that it's not the sole reason. "Currently, the overall change in the percentage of all candidates passing the NAVLE is not attributable to a single source or cause," she said, although she added that the declining performance is "similar to what is being seen in passing rates across a variety of examinations in the health professions and other standardized assessments since the Covid pandemic began in 2020."
Another variable is that more individuals are taking the test, reflecting the rise of new and expanding veterinary schools. According to the September edition of the ICVA newsletter, 2,357 candidates took the NAVLE during a four-week testing window in April 2023, marking a surge of 676 candidates or 40% increase compared to the previous year. Another 6,505 candidates applied to take the exam during the six-week testing window that began Nov. 1 and is ongoing. That's a rise of 8%, or 504 more candidates than the previous year.
The much larger increase in the number of April test-takers might indicate that greater numbers of students failed the test the previous fall. However, the ICVA has not indicated in its reports what proportion of test-takers in either round were first-timers or repeaters. A score of 425 out of 800 possible points is needed to pass the exam.
Careers in limbo
One 2023 graduate who has twice failed the NAVLE shared her story last week with VIN News on condition of anonymity, citing sensitivities around still having to pass the exam and find a job. The student said that after failing once, she was especially nervous about seeing her results the second time. She was at work when the score arrived in her inbox. She refrained from opening the email until she was home, with her partner on the phone for support.
She closed her eyes, then opened them, daring to hope. She peeked at the screen.
In disbelief, she saw that she had missed a passing score by 10 points. "I failed the NAVLE again," she said. "I felt pretty defeated."
Early on, she hadn't anticipated anything like this. "Our school was always, 'Hey, look at the stats: All these other vet schools pass on the first try, so your chances of passing are 95%-plus,' " she said, describing general attitudes toward the exam. "And that just wasn't true. I feel a lot of us were relying on that, for some reason."
Another new graduate who failed twice is Dr. Alexandra Melikian. Asked what the university conveyed to her and her classmates about their collective performance on the test, she said, "They told us we didn't hit 80%, I believe in an email, but that's it."
The rising seniors on whom the program's hopes for full accreditation now ride, however, were fully informed, according to Melikian: "They told the class below us in a big PowerPoint presentation, so they know we didn't get accredited and what it means for them."
Melikian attributes her trouble with the NAVLE to test anxiety but said starting veterinary school the same year that a pandemic hit didn't help.
"In the school's defense, we did start during a pretty rough time," she said. "I think that's honestly why NAVLE scores nationwide have been so low. We did labs in person, but we had to wear full PPE [personal protective equipment], and we did everything else online. For the most part, I just remember sitting in my living room trying to get through Zoom. Trying to translate a program that's hands-on into something on a screen is difficult. I don't think we got a lot out of it."
The majority of students, of course, did conquer the test despite their collective difficulties.
Dr. Terese Seidel calls NAVLE "the toughest exam I've ever taken" but passed on her first try. Reflecting on her veterinary school experience, she said "I felt the school prepared me for the exam and clinical year and that the pandemic did not have a significant effect on me.
"That is not to say the pandemic didn't have an effect on others," she added, "only that for me, I was able to manage it."
Is distributed learning a possible factor?
Another variable that some speculate might contribute to instances of poor NAVLE preparedness is the nature of the clinical training. At UA, as at most new schools, students are sent to private and corporate practices and other off-campus locations to acquire clinical skills rather than learning on campus at a teaching hospital. Some UA students who spoke with VIN News indicated that their training was uneven, varying from place to place.
For instance, one student described training at practices that didn't invest a lot of time in students unless they committed to taking employment there after graduation. But there were other placements in which students were treated as and expected to be active participants, particularly at sites like spay and neuter clinics.
Melikian, for her part, said she liked training off-campus. "I think shadowing at real practices showed us what it's like in real life to practice," she said. "It prepared us to face real clients, and the medicine is not always the 'gold standard.' Sometimes, you have to get creative."
Some UA students pointed to Lincoln Memorial University College of Veterinary Medicine in Harrogate, Tennessee, as having a comparable distributed learning model and potentially similar NAVLE concerns. But that program, which opened in 2014 and has been fully accredited since 2019, reports that its test scores have held steady since the pandemic, with a pass rate of 89%. The program's pre-pandemic NAVLE pass rate has reached as high as 97%.
Dr. Stacy Anderson, dean of the program, said LMU's test score stability does not, however, mean the pandemic had no effect on student performance. "We were fortunate to have gotten out in front of it, as you can see from our NAVLE trends, but we are still working on improving our post-Covid pass rates," she said by email. "And in reality, we are still experiencing the impact of Covid, as we are now admitting students who went through undergrad during Covid and seeing them struggle a bit more than usual in a professional program."
Anderson has hired two education specialists dedicated to aiding students at risk of falling behind. One of the specialists is tasked with guiding preparations for the NAVLE as the students approach graduation.
Further, Anderson extended students' break from clinical rotations from three to seven weeks to provide extra time to prepare for the test before the autumn examination period. "Four of those seven weeks are now a NAVLE preparation course," she said.
Finally, students are required to take an ICVA self-assessment multiple times in advance. "The performance on this test is highly correlated with performance on the NAVLE and allows us to help those students who are at risk of failing," Anderson explained.
"It will be interesting to see how the situation evolves," she said.
ICVA limits test retakes
Amid declining scores, the ICVA has alerted candidates of a coming change to its NAVLE retake policy.
Since 2007, the ICVA has recommended limiting candidates to five attempts within a five-year span, separated by a year between each of the final two attempts. However, state licensing boards can forgo that policy in favor of their own, and many impose no limit on the number of times a candidate could sit for the NAVLE.
That will change as of the November-December 2024 examination period when the organization imposes a tighter retake policy: Candidates wishing to sit for the NAVLE following five unsuccessful attempts must appeal to the ICVA and secure verification from a licensing board that they will accept the candidate's NAVLE score, should they pass the test on that attempt.
The new policy is retroactive to 2000, meaning that any attempt since that year will count toward the five-attempt limit. The ICVA has given advance notice of the change to licensing boards and candidates so that examinees from states without retake limits and who have failed five times can avail themselves of two last chances to take the test this fall or next spring, before the policy takes effect.
According to the ICVA website, imposing limits on the number of NAVLE attempts serves to minimize the risk that test questions are shared and yields a more accurate assessment of a candidate's knowledge level.
Some NAVLE candidates have raised concerns about the timing of the new policy, considering that they are still trying to overcome pandemic-related challenges.
"A lot of people are upset about this, and they're already worried about having to take the test again," Melikian said. "I've talked to people who are on their final attempts, and they're really stressed."