Academic Standards and Progression
Kristin P. Chaney, Kenita S. Rogers and Virginia Fajt
College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, USA
Developing and adhering to academic standards for progression is a critical component of highly successful veterinary programs. Academic standards often represent a collection of expectations that attempt to address the needs of accrediting bodies, stakeholders within the profession, faculty, members of curriculum committees, and students. In the modern professional education setting, standards must address academic coursework requirements, as well as competence in technical skills, nontechnical skills, and professional behaviors. Academic standards need to be consistent, fair, well communicated, and above legal reproach. In the veterinary profession, standards for progression are determined at the program level, and therefore often reflect institutions’ individuality.
Since the establishment of the first veterinary college in Lyon, France in 1761, professional veterinary medical education has continually evolved. There are several publications detailing the historical establishment of veterinary schools, evolution of curricula, and increasing diversity in student bodies (Smith, 2010, 2011a, b, 2013; Smith and Fenn, 2011; Fletcher, Hooper, and Schoenfeld-Tacher, 2015; Kochevar, 2015; Greenhill et al., 2015). However, despite their importance to ensuring quality within the profession, academic standards are infrequently mentioned in the literature. Both human and veterinary medical education programs have a clear obligation to society to deliver competent healthcare professionals, and defining standards for academic progression is where most programs begin. All programs have at-risk students who are more likely than others to fail to graduate, either through dropout or dismissal. Their academic performance lies at the threshold or below the standards of acceptable competence as determined by relevant institutions (Winston, van der Vleuten, and Scherpbier, 2010). This subset of students remains the primary focus of discussion related to setting standards, assessing competence, and providing remediation opportunities.
In many allied health science fields, including medicine, pharmacy, and nursing, governing bodies play an integral role in the establishment of standards and guidelines to ensure the quality of individual graduates (Poirier, Kerr, and Phelps, 2013; Giddens, Keller, and Liesveld, 2015). The American Veterinary Medical Association Council on Education (AVMA-COE) holds veterinary programs to high standards for accreditation, requiring evidence that students are observed and assessed for attaining competence in nine specific areas. It recently updated the standards to require that processes be in place to remediate students who do not demonstrate competence in these prescribed areas. Regardless, the creation of academic standards for individual student progression is left to the independent discretion of veterinary education programs. With the wide variety of educational models, this customized independence allows each program to define its own academic standards for progression, recognizing that without sufficiently rigorous standards it would be possible to graduate students who were not uniformly qualified, and making a discussion of veterinary academic standards relevant and necessary.
In veterinary medical education, standards for academic progression are determined by a wide variety of stakeholders. Each veterinary college must uphold programmatic standards as established by the AVMA-COE to maintain accreditation. For example, programs are required to maintain specific passing rates for the national licensing examination (NAVLE), although direct individual student standards for progression are left to the discretion of each program. In allied health fields, governing bodies often presume a more intensive role in the academic progression of students. The current Accreditation Council for Pharmacy Education (ACPE) requires schools to provide individualized assistance to students with academic difficulty. As of 2016, this governance by the ACPE extends to include language for “identifying and intervening when students have academic difficulty” (Moser et al., 2015). Many veterinary programs meet additional standards for accreditation defined at the university level by higher education commissions. Contributions to standards are also created by faculty, curriculum committees, administration, and legal counsel at each institution. To ensure that the integrity of the standards is maintained, faculty members must receive administrative support. Administrative personnel should understand the academic standards for their institution, be willing to adhere to those standards, and support faculty to ensure that standards are consistently applied and upheld. Without intentional demonstration of administrative support, faculty may find it difficult to maintain the standards for individual students (Poirier, Kerr, and Phelps, 2013). Upholding academic standards requires diligence and consistency across the entire educational program (Irby and Milam, 1989). In summary, academic standards need to be consistent, fair, well communicated, and above legal reproach.
As a discipline, veterinary educators should consider the following areas on which to base standards for academic progression: foundation knowledge, technical skills, nontechnical skills (communication, leadership, and teamwork), professional behaviors (ethical/moral reasoning, personal decision-making), and clinical rotation assessments.
Foundation knowledge is the critical educational component that allows students to grow academically and clinically, and supports their ability to problem-solve and think critically. Important tactics for the promotion of student progression in this setting include employing instructional techniques that focus on the student-learner and assessment strategies that highlight critical thought and reasoning skills. Students’ grade point average (GPA) is the most frequently used means of assessing their mastery of foundation knowledge and, as such, is commonly employed as an academic standard. An interesting study from Kansas State University explored grade inflation in veterinary medicine. It suggested that “a change in academic standards and student evaluation of teaching may have contributed to relaxed grading standards and technology in the classroom may have led to higher (earned) grades as a result of improved student learning” (Rush, Elmore, and Sanderson, 2009, p. 107). This concept is not unique to veterinary education and has been identified as a concern in other health professions (Shoemaker and DeVos, 1999; Speer, Solomon, and Fincher, 2000).
Technical skills are an inherent component of veterinary competence, so many programs are engaging in skills assessments that can be considered an academic standard or barrier to progression. Numerous programs have employed directed examinations, including objective structured clinical examinations (OSCEs), as a required assessment for progression.
The NAVMEC report (NAVMEC Board of Directors, 2011) confirmed the importance of business acumen, leadership, multicultural awareness, and interpersonal skills to successful veterinary careers. Historically, nontechnical skills have been neglected in favor of instruction in foundation knowledge and technical skills, but many programs now recognize the need to intentionally instruct students in these skills and have them woven into veterinary curricula. Indeed, these skills must be repeatedly practiced throughout the program to ensure that students achieve confidence and understanding (Burns et al., 2006). Practicing nontechnical skills from the earliest point within a curriculum promotes stronger veterinary graduates, making it important to consider the relevance of such skills as an academic standard for progression.
Some students admitted to professional programs are fully capable of negotiating the academic challenges associated with veterinary education, but may still struggle in the consistent demonstration of appropriate professional behaviors. Behaviors such as time management, suitable dress, personal hygiene, and moral/ethical reasoning may be innate characteristics of the ideal student, but for some these behaviors must be learned and practiced. This is also recognized in human medical education, and published work has shown an association between lack of professional behaviors in the educational program and disciplinary actions against physicians following graduation (Papadakis et al., 2005). A study of human medical students demonstrated that those with difficulty on clerkships in the third and fourth years of the program often manifested problematic behaviors earlier in medical school, where remediation may have been successful at improving their professional behaviors (Papadakis, Loeser, and Healy, 2001). This remains an important consideration for veterinary education programs, since regardless of career choice, professional behaviors are central to success. There are many doctor of veterinary medicine (DVM) programs that combine professional behaviors with nontechnical skills as a measure of academic performance and progression for students on clinical rotations during their final years. However, these behaviors should be assessed from the earliest possible time point in the curriculum to encourage early remediation if necessary.
Clinical Rotation Assessments
There are many different models of education under the AVMA umbrella, all of which include clinical rotations in the final year(s) of the program. Assessment of performance on clinical rotations serves as an important academic standard for progression and graduation. Clinical rotations act as the final opportunity for students to apply their foundation and clinical knowledge in real-life situations. Students’ performance on clinical rotations, termed “workplace-based assessments” in many programs, should include assessments of nontechnical skills including leadership and communication, as well as professional behaviors (Hecker, Norris, and Coe, 2012; Weijs, Coe, and Hecker, 2015).
Numerous assessment options are available, with no single method being appropriate or useful for all standards (Vandeweerd et al., 2014), although some are better suited to specific types of activities. Options for assessment include letter grading, pass/fail grading, OSCEs, Day One Competencies/skills lists, capstone experiences, barrier exams, proficiency scales/rubrics, professional behavior evaluations, and standardized examinations.
Letter and Pass/Fail Grading
Most letter grading schemes are based on a 10-point scale with designations of A through F. In some cases a plus/minus system is also used in an attempt to discriminate further between student performance levels. Of interest is a recent publication in the veterinary literature that describes various methods of reporting calculated grades, and questions whether grades truly represent what a student knows or can do (Royal and Guskey, 2015). This issue is pivotal to defining and maintaining academic standards, and demonstrates the challenges associated with making judgments regarding student progression. If a program utilizes individual course grades as an assessment for meeting standards, each program must identify the accumulated number of unsatisfactory grades, typically Ds or Fs, that triggers remediation or results in dismissal. In a recent survey of pharmacy schools with published guidelines for academic standards, a wide range of criteria for progression (or dismissal) were reported: “cumulative GPA or specific GPA post-probation or suspension; number of times on probation; certain number of F, D, or combination of F and D grades; failing a course more than once; failing two advanced pharmacy practice experiences; or exceeding the matriculation time limit” (Poirier, Kerr, and Phelps, 2013, p. 3).
Changing from letter to pass/fail (P/F) grading has been shown to increase medical students’ wellbeing without having an impact on performance in licensing examinations (Bloodgood et al., 2009; Reed et al., 2011; Spring et al., 2011). In dental education, research has shown no difference in the results of dental board examination pass rates when switching to P/F systems, and even demonstrated support for the use of such systems to increase self-regulated and lifelong learning. This study also suggested that specific (letter) grades are not important for maintaining standards (Leske and Ripa, 1985). White and Fantone (2010, p. 469) found that “Pass-fail grading can meet several important intended outcomes, including ‘leveling the playing field’ for incoming students with different academic backgrounds, reducing competition, fostering collaboration among class members, and more time for extracurricular interests and personal activities.” In other reports, moving to P/F grading in medical education has not been beneficial (Gonnella, Erdmann, and Hojat, 2004) or has shown mixed results (McDuff et al., 2014). An online discussion held among Association of American Veterinary Medical Colleges (AAVMC) associate deans related to schemes of P/F versus letter grading for clinical-year rotations revealed 17 out of 20 responding schools reporting letter grading, and 3 schools reporting use of a P/F or satisfactory/marginal/fail scheme.
Objective Structured Clinical Examinations
OSCEs and mini clinical examinations (mini-CEX) are used in professional programs in both North America and elsewhere. Many veterinary schools have adapted this type of structured clinical examination for use in both preclinical and clinical programs. The most valuable aspects of OSCEs and mini-CEX are the ability to standardize the assessment, provide students with a timed clinical experience, and incorporate additional nontechnical skills into the assessment. There is scientific support for both the validity and the reliability of OSCEs, and some programs include this type of examination as a barrier to progression. If OSCEs are introduced into a curriculum, additional components that must be incorporated to ensure academic progression include opportunities for student practice in preparation for examinations, and appropriate remediation measures for students who are unsuccessful. There is evidence in the medical literature to suggest that the most effective remediation measures include not only review of the material (i.e., practice), but also self-reflection and self-assessment. When these measures are combined, students have demonstrated improved performance on subsequent clinical examinations (White, Ross, and Gruppen, 2009).