Post on 16-Jul-2015
AVMA Educational Commission for Foreign Veterinary Graduates
Canadian National Examining Board
1
Clinical Proficiency Examination
(CPE)
Standard Manual of Administration
2012 Edition
For use ONLY in CPE administrations during calendar year 2012
CLINICAL PROFICIENCY EXAMINATION General Information
Standard MOA 2012
For use ONLY during calendar year 2012 ii
TABLE OF CONTENTS
GENERAL INFORMATION ....................................................................................................................................1
Statement of Intent .................................................................................................................................................1
General Discussion about the CPE .......................................................................................................................1
Guidelines for Temporarily Disabled, Pregnant, or Candidates Requesting Testing Accommodations ...............1
Rules of Conduct ....................................................................................................................................................2
Quality Assurance ..................................................................................................................................................6
General Requirements ............................................................................................................................................6
Layout of CPE ........................................................................................................................................................7
Information Supplied To Candidates .....................................................................................................................7
Requirements of Candidates ..................................................................................................................................7
Supplies Candidates Must Provide ........................................................................................................................8
Assessment of Candidates ......................................................................................................................................8
Other Considerations in Candidate Assessment ....................................................................................................8
Passing Standard and Score Reporting .................................................................................................................9
Candidates Not Passing All Sections .....................................................................................................................9
Use of Reference Material .....................................................................................................................................9
Feedback to Candidates .........................................................................................................................................9
Common Diagnoses/Conditions .............................................................................................................................9
References for the CPE ........................................................................................................................................10
Animal Requirements ...........................................................................................................................................11
Personnel Requirements ......................................................................................................................................12
Facilities and Equipment .....................................................................................................................................12
Suggestions for Scheduling and Timing of the CPE ............................................................................................13
Other Policy Information .....................................................................................................................................14
ANESTHESIA .........................................................................................................................................................15
A. Competencies ...................................................................................................................................................15
B. Time .................................................................................................................................................................15
C. Set-up Information ...........................................................................................................................................15
D. Requirements of the Candidate .......................................................................................................................18
E. Anesthesia Final Score Sheet ..........................................................................................................................20
F. Appendices .......................................................................................................................................................24
Appendix 1—Fatal Flaws ................................................................................................................................24
Appendix 2—Preanesthetic Physical Status ....................................................................................................25
Appendix 3—Anesthesia Record ......................................................................................................................26
EQUINE PRACTICE ...............................................................................................................................................30
A. Competencies ...................................................................................................................................................30
B. Time .................................................................................................................................................................30
C. Set-up Information ...........................................................................................................................................30
D. Requirements of the Candidate .......................................................................................................................33
Station 1–Clinical Evaluation ..........................................................................................................................33
Station 2–Clinical Techniques .........................................................................................................................36
Station 3–Lameness Evaluation .......................................................................................................................38
E. Equine Practice Summary and Final Score Sheet ...........................................................................................41
FOOD ANIMAL PRACTICE ..................................................................................................................................42
A. Competencies ...................................................................................................................................................42
B. Time .................................................................................................................................................................42
C. Set-up Information ...........................................................................................................................................42
D. Requirements of the Candidate .......................................................................................................................45
Station 1–Clinical Case, Bovine ......................................................................................................................45
CLINICAL PROFICIENCY EXAMINATION General Information
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Station 2–Clinical Case, Other Food Animal ..................................................................................................48
Station 3–Clinical Procedures .........................................................................................................................51
Station 4–Bovine theriogenology and public health, food safety, and regulatory issues ................................53
E. Food Animal Practice Summary and Final Score Sheet .................................................................................56
NECROPSY .............................................................................................................................................................58
A. Competencies ...................................................................................................................................................58
B. Time Limit ........................................................................................................................................................58
C. Set-up Information ...........................................................................................................................................58
D. Requirements of the Candidate .......................................................................................................................60
E. Necropsy Final Score Sheet .............................................................................................................................61
RADIOGRAPHIC POSITIONING ..........................................................................................................................62
A. Competencies ...................................................................................................................................................62
B. Time Limit ........................................................................................................................................................62
C. Set-up Information ...........................................................................................................................................62
D. Requirements of the Candidate .......................................................................................................................64
E. Radiographic Positioning Final Score Sheet ..................................................................................................65
SMALL ANIMAL MEDICINE ...............................................................................................................................66
A. Competencies ...................................................................................................................................................66
B. Time .................................................................................................................................................................66
C. Set-up Information ...........................................................................................................................................66
D. Requirements of the Candidate .......................................................................................................................68
Station 1–Clinical Evaluation ..........................................................................................................................68
Station 2–Medical Management ......................................................................................................................71
E. Small Animal Medicine Summary and Final Score Sheet ...............................................................................73
F. Appendices .......................................................................................................................................................74
Appendix 1—History and Physical Examination Form (for use in SAM Station 1) ........................................74
Appendix 2—Prescription Form (for use in SAM Station 2) ...........................................................................76
Appendix 3—Medical Management and Treatment Order Form (for use in SAM Station 2) .........................77
SURGERY ...............................................................................................................................................................84
A. Competencies ...................................................................................................................................................84
B. Time .................................................................................................................................................................84
C. Set-up Information ...........................................................................................................................................84
D. Requirements of the Candidate .......................................................................................................................86
E. Surgery Final Score Sheet ...............................................................................................................................88
F. Appendices .......................................................................................................................................................92
Appendix 1—Fatal Flaws ................................................................................................................................92
CLINICAL PROFICIENCY EXAMINATION General Information
Standard MOA 2012
For use ONLY during calendar year 2012
1
GENERAL INFORMATION
Statement of Intent
The Clinical Proficiency Examination (CPE) is an examination for international veterinary graduates
wishing to gain educational equivalency or pursue licensure in the United States or Canada, respectively,
and who have not graduated from a veterinary school accredited by the American Veterinary Medical
Association (AVMA) Council on Education (COE). In some instances, the Canadian National
Examining Board (NEB) also uses the CPE for examination of graduates of veterinary schools
accredited by the AVMA COE who have not been successful on the national licensure examination. The
CPE is intended to assess the practical clinical veterinary skills of an “entry-level” veterinarian (ie, a
new graduate of an AVMA/COE-accredited school). Each site administering the CPE must comply with
all laws within their jurisdiction (eg, those relating to animal use and drug availability). Further, a site
must report any legally necessary deviation from this Manual of Administration to the AVMA’s
Educational Commission for Foreign Veterinary Graduates (ECFVG) or to the NEB for final approval.
The ECFVG and NEB will notify candidates of legally necessary deviations.
General Discussion about the CPE
The Standard Manual of Administration (MOA) has been prepared for use by examiners, candidates, and
veterinary mentors. Candidates are urged to carefully read this MOA and understand the skill
requirements of the CPE. After having done this, the candidate will be able to self-assess his/her
competencies to determine those areas of weakness that require further training/education. If further
training/education is required, the support and expertise of a veterinary mentor is strongly recommended
prior to scheduling and attempting the CPE.
A candidate preparing to take the CPE should develop a familiarity with the animal species specified by
the exam. Throughout the CPE, there is greater emphasis placed on the dog, cat, horse, and cow. The
candidate is advised to focus on these species. A candidate lacking in experience working with any of
these species should seek this experience before taking the examination. This may mean working with
the animals in a non-veterinary capacity doing such things as feeding, cleaning, exercising, restraining,
grooming and routine health care (eg, equine foot care).
Although experience gained from reading material and viewing video tapes, kodachromes, etc, is helpful
in preparation for the CPE, the candidate must not consider these to be a substitute for the experience
outlined above.
Communication skills and service to clients form a high priority in veterinary practice in the United
States and Canada. Throughout the CPE there are frequent requirements of the candidate to
communicate with a client (role played by the examiner). This occurs most often during history taking
and communicating a clinical message to a client. Throughout the CPE the candidate must be able to
demonstrate the ability to take a history from a client by asking appropriate questions. Lack of
adequate entry-level communication skills in English (or French at the Université de Montréal, St.
Hyacinthe for NEB purposes only) will negatively impact a candidate’s performance on the CPE.
Guidelines for Temporarily Disabled, Pregnant, or Candidates Requesting Testing
Accommodations
The nature of the CPE necessitates usage of live animals. While every attempt is made by examination
personnel to use animals of mild temperament, the behavior of such animals cannot be predicted, and there is a
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potential hazard to candidates, particularly those who are temporarily disabled or pregnant. In addition to the
trauma that may result from working with animals, particularly large animals, hazards exist for the unborn child
whenever a pregnant candidate is exposed to infectious agents, inhalant anesthetics, radiation and other agents.
Of special concern is the particular hazard of radiation and inhalant anesthetic gases to the unborn. For this
reason, a candidate who is in the first 20 weeks of pregnancy must be withdrawn from any part of the
examination that could result in exposure.
A candidate who becomes temporarily disabled or pregnant after being accepted to take the CPE is
required to notify the administrative office (ie, ECFVG or NEB office) as soon as possible. The
administrative office will require documentation of the temporary disability or pregnancy. The office
will immediately notify the examination site.
Options for the candidate include:
1. Temporary withdrawal from the CPE with the right to resume at the first available opening
without losing any deposits or fees.
2. Participate in the scheduled CPE. The candidate will complete an informed consent form to
ensure the selection option is understood, together with the hazard that may exist, without
holding the examination site, ECFVG/AVMA or NEB/CVMA liable for injury/disorder(s) that
may develop associated with the CPE.
The examiner has the full right, as well as the moral and legal responsibility, to refuse to allow a
disabled/pregnant candidate to participate in a section of the examination when said examiner(s)
consider(s) or know(s) the section(s) to be potentially hazardous to the candidate and/or unborn child.
A candidate may appeal any decision imposed under the above guidelines by presenting a written
statement to the chair, ECFVG c/o American Veterinary Medical Association, 1931 North Meacham Rd,
Suite 100, Schaumburg, IL, 60173-4360 or chairman, NEB c/o Canadian Veterinary Medical
Association, 339 Booth St, Ottawa, Ontario, K1R 7K1. ECFVG candidates may also refer to the
ECFVG Policies and Procedures Manual at www.avma.org/education/ecfvg/ecfvg_pp_toc.asp for the
ECFVG appeal procedure.
Candidates requesting testing accommodations in compliance with the Americans with Disabilities Act
(ADA) should refer to the Testing Accommodations procedures outlined in the CPE Candidate Bulletin
(available at www.avma.org/education/ecfvg/default.asp.
Rules of Conduct
The ECFVG has established Rules of Conduct to govern administration of the CPE to ensure that no
examinee or group of examinees receives unfair advantage on the examination, inadvertently or
otherwise.
If there is a reason to believe that the integrity of the examination process is jeopardized, the ECFVG
may invalidate all or any part of a CPE administration. If information indicates that continued testing
would jeopardize the security of examination materials or the integrity of scores, the ECFVG reserves
the right to suspend or cancel any CPE administration.
CPE site team members (ie, coordinators, examiners, technicians, and assistants) monitor all sections of
the CPE. If CPE site team members observe a candidate violating the Rules of Conduct or engaging in
other forms of irregular behavior during a CPE, the team members will not necessarily advise the
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candidate at the time of the examination, but shall report such incidents to the ECFVG (or NEB for
Canadian sites). Each report shall be fully investigated, with the ECFVG or NEB making the final
decision.
By applying to take the CPE, a candidate agrees to the following Rules of Conduct:
You are the person named on the CPE application.
You will place in a locker or cubicle all personal belongings, including cellular telephones,
watches with computer communication and/or memory capability, pagers, personal digital
assistants (PDAs), formulas, study materials, notes, papers, and your purse or wallet, before you
enter the secure testing areas.
You will not use a telephone at any time while you are in the secure areas.
You will not give, receive, or obtain any form of unauthorized assistance during the testing
session, including any breaks.
You will not have in your possession any formulas, study materials, notes, papers, or electronic
devices of any kind unless you are out of the secure testing areas of the CPE site.
You will not remove materials in any form (written, printed, recorded, or any other type) from
the secure testing area unless instructed to do so by the examiners.
You understand and acknowledge that all examination materials remain the property of the CPE
site and ECFVG, and you will maintain the confidentiality of the case content for all six sections
of the CPE. You will not reproduce or attempt to reproduce examination materials through
memorization or any other means, nor will you provide information relating to examination
content that may give or attempt to give unfair advantage to individuals who may be taking the
examination, including, without limitation, by posting information regarding examination
content on the Internet.
Personal Belongings—Unless specifically authorized, candidates may not bring personal belongings
into secure testing areas of the CPE site. Failure to follow these rules shall constitute a violation of the
Rules of Conduct for the administration of the CPE and may lead to adverse action regarding a
candidate’s examination. For the CPE, candidates should understand that the entire testing session over
the 3- to 4-day testing period, including all breaks, is considered a closed and secure testing session, and
that the entire CPE site, including any on-site lunch room, break rooms, and restrooms, is a secure
testing area. Therefore the rules regarding unauthorized possession during the CPE extend to lunch, if
lunch is provided on site, and all breaks.
For the CPE, unauthorized personal belongings include, but are not limited to:
mechanical or electronic devices, such as cellular telephones, personal digital assistants (PDAs),
watches with computer communication and/or memory capability, electronic paging devices,
recording or filming devices, radios;
outerwear, such as coats, jackets, head wear, gloves;
book bags, backpacks, handbags, briefcases, wallets; and
books, notes, study materials, or scratch paper.
If candidates bring any personal belongings to the CPE site, they must store them in a designated locker
or storage cubicle as directed by the CPE site team. All stored mechanical or electronic devices must be
turned off. Upon reasonable suspicion, a candidate’s personal belongings and their contents may be
inspected. Any materials that reasonably appear to be reproductions of any case material specific for the
CPE administration in which a candidate is participating will be confiscated. Making notes of any kind
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during the CPE, except on the materials provided by the CPE site for this purpose, is not permitted. If
candidates have any questions regarding the appropriateness of personal belongings to be brought into
the CPE site, contact the ECFVG or a CPE site team member prior to admission.
Admission to the CPE—When candidates arrive at the CPE site for orientation and check in for the full
CPE or to retake one or more sections, they must present a photo ID with signature. Acceptable forms of
identification include the following forms of unexpired identification:
passport;
driver's license;
national identity card; or
other form of unexpired, government-issued identification.
The identification must contain both the candidate’s signature and photograph. If a candidate does not
bring acceptable identification, he/she will not be admitted to the CPE. In that event, the candidate will
be required to reschedule the CPE in accordance with current ECFVG policy.
The candidate’s name as it appears on his/her CPE application must match the name on the
form(s) of identification exactly. If a candidate’s name listed on his/her CPE application is not
correct, contact the ECFVG office immediately at ECFVG@avma.org or 800-248-2862, ext 6682
or 6623. If you registered to take the CPE through the NEB, please contact the NEB directly at
(613) 236-1162.
Test Centers and Testing Conditions—For ECFVG candidates, the time and location for arrival at the
CPE site for orientation and check in will be sent to each candidate by US mail prior to the
administration of the examination. If a candidate arrives late, he/she will not be admitted, and will have
to reschedule the test date in accordance with current ECFVG policy.
At the time of check-in, candidates will be required to present unexpired photo identification with
signature. Prior to beginning each day of the examination, candidates will be directed to a small storage
cubicle or locker in which they must place personal belongings. These cubicles may not be secure, so do
not bring valuables.
In addition, please note the following:
You should bring only the equipment specified for each section within the CPE Manual of
Administration; all other equipment is provided at the CPE.
You should wear comfortable, professional clothing.
There are no waiting facilities for family and friends at the center; plan to meet them elsewhere
after the examination ends.
CPE site team members (wearing name tags) will direct you throughout each day of the CPE,
and their instructions should be followed at all times.
There will be an on-site orientation to each section of the CPE to acquaint candidates with specific
procedures and regulations.
Once candidates enter the secure testing area of the CPE site, they may not leave that area until directed
to do so by a member of the CPE site team. Breaks, including a lunch break, are provided. CPE site team
members will direct candidates to any on-site break and lunchrooms.
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Candidates may not discuss the cases with fellow examinees at any time, and conversation among
examinees in any language other than English (or French at the Université de Montréal, St.
Hyacinthe) is prohibited at all times. CPE site team members will monitor all examinee activity.
See “Irregular Behavior” below.
CPE site team members are not authorized to answer questions from examinees regarding examination
content or scoring.
Should a candidate wish to file a concern regarding the CPE testing experience, he/she may do so at the
site on the test day(s). If a candidate does not file a report at the site, he/she must notify the ECFVG
office in writing within three weeks of the final day of the administration of the CPE. Concerns that are
reported in this way will be investigated in accordance with the current ECFVG Complaints Procedure,
available in the Policies and Procedures Manual at www.avma.org/education/ecfvg/ecfvg_pp_toc.asp.
Note: Visitors as approved by the ECFVG or NEB, may, on some occasions, be observing a CPE in
progress. Other than site evaluators, they will be given no information regarding examinee identity
or performance and will have no interaction with examinees.
Irregular Behavior—Irregular behavior consists of any action by CPE candidates or others that subverts
or attempts to subvert the examination process, including, without limitation:
Falsification of information on the application form, including additional documentation, or failure
to provide the ECFVG with information material to your application.
Impersonating an examinee or engaging someone else to take the examination for you.
Giving, receiving, or obtaining unauthorized assistance during the examination, or attempting to do
so.
Unauthorized possession, reproduction, or disclosure of any materials, including, but not limited to,
examination cases, before, during, or after the examination.
Making notes of any kind during an examination except on the writing materials provided by the
CPE for that purpose.
Disruptive or unprofessional behavior at a CPE site.
Offering any benefit to any CPE site team member or agent of the ECFVG in return for any right,
privilege, or benefit which is not usually granted by the ECFVG to other similarly situated
candidates.
NOTE: Talking to another examinee during the examination may be reported as evidence of giving,
receiving, or obtaining unauthorized assistance.
If a candidate is determined to have failed to abide by the Rules of Conduct of the ECFVG or
otherwise to have engaged in any form of irregular behavior, the ECFVG may terminate the
candidate’s participation in an examination, invalidate the results of an examination, withhold or
revoke the candidate’s scores or certification, bar the candidate’s participation in future
examinations, and/or take other appropriate adverse action. In addition, such determination shall
become part of the candidate’s permanent ECFVG record and the fact of such determination may
be provided to third parties that receive or have received verification of ECFVG status. Such
information may also be provided to other legitimately interested entities.
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Candidates also should understand that the ECFVG may or may not require a candidate to retake one or
more portions of the ECFVG if presented with sufficient evidence that the security of the examination
has been compromised, notwithstanding the absence of any evidence of a candidate’s personal
involvement in such activities.
Appeal Process—ECFVG candidates determined to have violated the Rules or Conduct or otherwise
engaged in irregular behavior may appeal the decision by following the current ECFVG Appeal
Procedure available in the ECFVG Policies and Procedures Manual at
www.avma.org/education/ecfvg/ecfvg_pp_appeal.asp. NEB candidates must contact the NEB office.
Quality Assurance
All CPE sites (existing or new) must agree to be monitored by the Educational Commission for Foreign
Veterinary Graduates (ECFVG) or the National Examining Board (NEB) of the Canadian Veterinary
Medical Association. The process for monitoring CPE sites is described in the ECFVG document titled
Quality Assurance for the CPE—Site Proposal, available as an appendix in the CPE Candidate Bulletin
at www.avma.org/education/ecfvg/default.asp.
General Requirements
The CPE is a hands-on examination of entry-level educational clinical skills and judgments designed for
graduates of non–AVMA COE-accredited veterinary colleges. Additionally, the National Examining
Board (NEB) of Canada uses the CPE to examine each graduate of an accredited college who twice fails
the North American Veterinary Licensing Examination (NAVLE).
The CPE Manual of Administration (MOA) describes specific sections and skills to be assessed and
serves as the guide for administering the CPE to all candidates. All sites must adhere to the standards
set forth in the CPE Manual.
In order for any entity to become a CPE provider, three resource areas must be assured. The site must
provide appropriate animals and their care, qualified personnel, and adequate facilities and equipment.
A private site is defined as any site other than an AVMA-accredited school/college of veterinary
medicine.
A candidate for the CPE will not be assessed at an examination site which is a school/college of
veterinary medicine if:
He/she is a graduate of that school/college.*
He/she has participated in a clinical training program at that school/college.*
He/she is an employee or former employee of that school/college.*
*Exception only for Université de Montréal, St. Hyacinthe (French speaking; for NEB purposes only).
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Layout of CPE
The following seven sections make up the CPE.
Anesthesia (AN)
Equine Practice (EQ)
Food Animal Practice (FAP)
Necropsy (NEC)
Radiology (RAD)
Small Animal Medicine (SAM)
Surgery (SU)
Each section of the CPE Manual of Administration is laid out as follows:
A. Competencies. Outlines those skills on which the candidate will be assessed.
B. Time
C. Set-up information. Will assist veterinary examiners and support staff in examination
preparation and provide the candidate with a 'picture' of the testing environment. Included
in the set-up information is a description of the:
1. Animal requirements
2. People requirements
3. Facilities and equipment
4. Supplies/information provided by the examiner
5. Supplies provided by the candidate
6. Special equipment or supplies specific for the section
D. Requirements of the candidate. Describes specific skills that will be required of the
candidate by station and/or area as appropriate. Includes examples of assessment sheets
that will be used.
E. Summary and/or final score sheet for the section.
F. Appendices if appropriate for the section
Information Supplied To Candidates
In all of the examination sections, the examiners will provide the candidates with an orientation to the
examination room(s), supplies and equipment, including dosages of all drugs required by the CPE. The
quality of the examination facilities will be consistent with those in common use in veterinary practice in
the United States and/or Canada. The examiners will provide the candidates with copies of forms
included in various parts of the CPE Manual of Administration that are required for completion by the
candidate and also will provide paper for rough work (if required).
Requirements of Candidates
Section D of each section contains paragraphs that outline groups of clinical proficiency skills expected
of the candidate. Following each paragraph is an assessment table that lists the required skills outlined in
the preceding paragraph and the maximum point score allocated for each skill and provides a space for
the veterinary examiner to enter the candidate's score. Using Section D of Equine Practice as an
example, Part 1 contains a paragraph that outlines the skills associated with the examination of the
equine clinical case. At the end of the descriptive paragraph is the table of assessment (EQ01
ASSESSMENT).
At the conclusion of each of the sections within this MOA—except for Necropsy, Radiology, Surgery
and Anesthesia—is a summary assessment sheet to tabulate the candidate's scores from each group of
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skills (ie, station) within the section. The summary assessment sheet indicates the weighting for each
station and provides a space to enter the final weighted points achieved by the candidate. Using Equine
Practice as an example, the score sheet is the last table of the Equine Practice section (EQ04 SCORE
SHEET).
Supplies Candidates Must Provide
Although the incidence of rabies in domestic animals within the USA and Canada is extremely low, the
ECFVG strongly encourages candidates to complete vaccination against rabies prior to taking the CPE.
Each section of the CPE Manual of Administration lists supplies that must be provided by the candidates
for that specific section and may include:
clean laboratory coat
coveralls (except for necropsy; necropsy coveralls are provided by site)
dosimeter (optional; if the candidate wishes to monitor personal levels of radiation during the
examination, the candidate will provide his/her own dosimeter)
penlight
digital rectal thermometer (large and small animal)
safety boots (except for necropsy; necropsy boots/shoe coverings are provided by site)
stethoscope
wristwatch with second hand
surgical scrubs
pens/pencils
Assessment of Candidates
The Manual of Administration specifies the knowledge and technical skills (globally referred to as
clinical proficiency skills) that will be asked during the examination.
Examiners will assess each candidate’s knowledge and technical skills by direct observation, and in
some cases, will assess their written descriptions of findings or conclusions.
For each of the seven sections of the examination, specific grading rubrics are published in the Manual
of Administration.
Other Considerations in Candidate Assessment
The term “efficiency” is an element in some of the assessments. Efficiency is a component of
competency. Candidates are to be assessed on their timeliness and effective use of resources to complete
a procedure.
A candidate who, in the judgement of the examiner, requires an unreasonable amount of time to the
extent that the outcome of the procedure is jeopardized will be penalized. The penalty for this type of
assistance will be reflected in the number of points assigned to the particular clinical skill. A candidate
who cannot complete a skill or set of skills in the maximum time allowed will be penalized and may
receive no points for a given station or section.
If a candidate compromises his/her personal safety or the safety of personnel while working around
animals during the course of the CPE (eg, too close to the rear legs of a horse), the examiner will
intervene, may terminate the procedure and will assign a penalty that will be reflected in the number of
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points assigned to the particular skill. The section may also be scored as UNSATISFACTORY (fail)
depending on the nature of the safety violation(s).
The examiner will assist an animal and terminate the section if a candidate by an act of omission or
commission puts an animal into an inhumane or life-threatening situation and the situation is not
corrected by the candidate. The section will be scored as UNSATISFACTORY regardless of the score
accumulated at the point of termination.
Passing Standard and Score Reporting
A score of 60 points or greater or a “pass” in each of the 7 sections of the CPE is required in order to
pass the entire examination.
Score reports (pass or fail only) from examinations administered at ECFVG-approved CPE sites will be
reported by the ECFVG office via US mail ONLY. Scores will be released no more than twenty (20)
business days following the final day of any given CPE administration. Scores CANNOT be released via
fax, telephone, or E-mail. To ensure timeliness in delivery of score reports, it is essential that candidates
update contact information immediately by E-mailing or faxing the ECFVG office (ECFVG@avma.org;
847-925-9329).
Scores from examinations administered at Canadian NEB-approved sites will be reported by the NEB.
Candidates Not Passing All Sections
A candidate with a “fail” in four or more sections of the examination must retake the entire examination.
A candidate with a “fail” in one, two, or three sections is allowed two additional opportunities to retake
and successfully pass the failed sections as long as the candidate applies for retakes within 6 months of
each failure and accepts one of the first available retakes offered. Failure to successfully pass the retake
sections within these 2 attempts or failure to accept one of the first available retakes will necessitate the
candidate retaking the entire CPE. only a total of two retake attempts are allowed for
each failed section, regardless whether those attempts are taken at an ECFVG- or NEB-approved CPE
site. The ECFVG and NEB offices will communicate with each other regarding candidates registered in
both programs.
Use of Reference Material
The CPE is an examination that measures a candidate's proficiency in performing veterinary clinical
skills at the entry level. The expectation is that each candidate will demonstrate the required skill
without reference material unless reference material is required for a specific portion of the
examination. In this case, the reference material is listed in the section Supplies/Information Provided
By The Examiner and will be supplied by the examiner.
Feedback to Candidates
An unsuccessful candidate may request standard feedback of the section(s) failed from the office of
administration (ie, ECFVG or NEB offices). For ECFVG candidates, please request feedback via E-mail
to ECFVG@avma.org. Candidates are prohibited from contacting examiners for feedback during
or after completion of the CPE.
Common Diagnoses/Conditions
The CPE is a test of “entry-level skills.” Therefore, cases/conditions selected for inclusion on the
examination should be common conditions with which the new graduate of an AVMA-accredited school
CLINICAL PROFICIENCY EXAMINATION General Information
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should be familiar. An example list of common diagnoses is maintained on the ECFVG website at
www.avma.org/education/ecfvg/cpe_common_diagnoses.pdf. Candidates and examiners must realize
that this list is not exhaustive and that there is no requirement that the CPE be limited to the diagnoses
and conditions on this list.
References for the CPE
The knowledge level expected to receive a passing score on the CPE is that of an entry-level US
veterinarian (ie, new graduate of an AVMA-accredited veterinary school). Reference lists for curricula
at accredited veterinary schools are extensive. The following list represents a relevant subset that
appropriately covers the content of the CPE. However, experience gained from reading material is
helpful in preparation for the CPE, the candidate must not consider these to be a substitute for hands-on
clinical experience.
1. Adams, HR. Veterinary Pharmacology and Therapeutics, 8
th ed. (2001), Iowa State Press.
2. Ballweber, L. Veterinary Parasitology-The Practical Veterinarian Series, (2000), Butterworth-Heinemann
3. Bertone J and Horspool LJI. Equine Clinical Pharmacology, 2004, Saunders
4. Birchard SJ and Sherding RG. Saunders Manual of Small Animal Practice, 3rd ed. (2006), Saunders.
5. Butler JA, Colles CM, Dyson SJ, et al: Clinical Radiology of the Horse, (1993), Blackwell Science Ltd.
6. Bonagura JB. Kirk’s Current Veterinary Therapy XIII, 2000, WB Saunders.
7. Boothe, DM. Small Animal Clinical Pharmacology and Therapeutics, 2001, Saunders.
8. Castro AE and Heuschele WP. Veterinary Diagnostic Virology, 1992, Mosby-Year Book.
9. de La Hunta A and Habel RE. Applied Veterinary Anatomy, 1998, Saunders.
10. Dennis R, Kirberger RM, Wrigley RH, et al. Handbook of Small Animal Radiological Differential
Diagnosis, (2001), Saunders.
11. Dyce KM, Sack WO, Wensing, CJG. Text Book of Veterinary Anatomy, 3rd
ed. (2002), Saunders.
12. Ettinger SJ and Feldman EC. Textbook of Veterinary Internal Medicine, 6th ed. (2005), Saunders.
13. Evans HE. Miller's Anatomy of the Dog, 3rd ed. (1993), Saunders.
14. Farrow CS. Veterinary Diagnostic Imaging-The Dog and Cat, (2003), Mosby.
15. Frandson RD, Wilke AD, Fails WL. Anatomy and Physiology of Farm Animals, 6th ed (2003) Blackwell.
16. Fossum TW, Hedlund CS, Hulse DA, et al. Small Animal Surgery, 3rd
ed. (2007), Mosby Year Book.
17. Gillespie JH, Timoney JF. Hagan and Brunner’s Microbiology and Infectious Diseases of Domestic
Animal, 1981, Comstock Publishing Associates.
18. Greene, CE, Infectious Diseases of the Dog and Cat, 3rd
ed. (2006) WB Saunders, CO.
19. Jones TC, Hunt RD, King NW. Veterinary Pathology, 6th ed. (1997), Academic Press.
20. Jubb KVF, Kennedy PC, Palmer, N. Pathology of Domestic Animals: 3-Volume Set, 4th ed (1992-1993),
Saunders.
21. Kealy JK and McAllister H. Diagnostic Radiology and Ultrasonography of the Dog and Cat, 3rd ed
(2000), Saunders. (please note there is a fourth edition published in 2005, but it was the 3rd
that was used)
22. Knottenbelt DC and Pascoe RR. Diseases and Disorders of the Horse, 2004, Butterworth-Heinemann.
23. Kumar V, Abbas AK, Fausto N. Robbins & Cotran Pathologic Basis of Disease, 7th ed. (2004) Saunders.
24. Latimer KS, Prasse KW, Mahaffey, EA. Duncan & Prasse's Veterinary Laboratory Medicine: Clinical
Pathology, 4th ed. (2003), Blackwell Publishing.
25. Lavin LM. Radiography in Veterinary Technology, 3rd
ed (2003), WB Saunders.
26. McGavin MD and Zachary JF. Pathologic Basis of Veterinary Disease, 4th ed. (2007), Mosby
27. The Merck Veterinary Manual. 9th ed.
28. Muir WW, Hubbell JAE, Skard R, et al. Handbook of Veterinary Anesthesia, 3rd
ed. (2000), Mosby.
29. Nelson RW and Couto CG. Small Animal Internal Medicine, 3rd
ed. (2000), Mosby.
30. Osborne CA and Stevens JB. Urinalysis: A Clinical Guide to Compassionate Animal Care, 1999, Bayer
Corp.
31. Plumb, D. Plumb's Veterinary Drug Handbook. 5th ed. (2005) Blackwell Publishing.
32. Pugh DG. Sheep and Goat Medicine, 2002, Saunders.
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33. Radostitis O, Gay CC, Blood DC, et al. Veterinary Medicine—A Textbook of the Diseases of Cattle,
Sheep, Pigs, Goats, and Horses. 9th ed. (2000), Saunders Ltd.
34. Reed SM, Bayly WM, Sellon DC. Equine Internal Medicine, 2nd
ed. (2004), Saunders.
35. Rollin B, Wilson, JF, and Jarbe JL. Law and Ethics of the Veterinary Profession, 2002, Priority Press Ltd
36. Ross MW and Dyson SJ. Lameness in the Horse, (2003), Saunders.
37. Slatter D. Textbook of Small Animal Surgery, 3rd
ed. (2003), Saunders.
38. Smith BP. Large Animal Internal Medicine. 3rd
ed. (2002), Mosby.
39. Speirs VC. Clinical Examination of Horses, 1997, Saunders.
40. Stashek T. Adams’ Lameness in Horses, 5th ed. (2002) Blackwell Publishing.
41. Stockham S and Scott MA. Fundamentals of Veterinary Clinical Pathology, 2002 Blackwell Publishing.
42. Thurmon J, Tranquilli W, and Benson GJ. Lumb & Jones' Veterinary Anesthesia & Analgesia, 3rd
ed.
(1996), Blackwell Publishing.
43. Thrall MA, Baker DC, Campbell TW, et al. Veterinary Hematology and Clinical Chemistry, 2004,
Lippincott Williams & Wilkins.
44. Thrall DE. Textbook of Veterinary Diagnostic Radiology, 4th ed. (2002), Saunders.
45. Willard MD and Tvedten H. Small Animal Clinical Diagnosis by Laboratory Methods, 4th ed. (2004),
Saunders.
46. Wingfield WE, Raffe MR. The Veterinary ICU Book, 2002, Teton NewMedia.
47. Youngquist, RS., Current Therapy in Large Animal Theriogenology, 1997, W.B. Saunders Company,
Philadelphia
Animal Requirements
It is imperative that the CPE site provide for humane care and treatment of animals. In order to assure
proper care and treatment, the following are required:
Animal resources (species, weights, age, sex, numbers, etc) must meet the standards set forth
in the CPE Manual of Administration.
Local, state, and United States federal animal welfare laws, or similar laws applicable in
Canada, must be enforced and the facility must meet the standards of the most current United
States Federal Animal Welfare Act or the Canadian Council on Animal Care.
Acceptable sources of live and necropsy animals and bovine fetuses may include the following:
Those consistent with Provincial Animals for Research Acts
United States Department of Agriculture, licensed animal dealers
Purpose bred animals
Animal Shelters
Food animal producers
Livestock sales
Slaughter houses
Institution/practice owned
Donated animals must be accompanied by a signed consent form from the donor.
Owned animals with signed consent from the owner.
In order to provide variation in clinical case presentations at each clinical station, a minimum of two (2)
clinical cases must be furnished (one shall be used for the morning group of candidates and another for
the afternoon group of candidates). Clinical cases used in a CPE site examination may not be used at
that site for three subsequent examinations. In addition, medical management records (Station 2 of the
Small Animal Medicine section) must be changed between groups of candidates during any one
examination.
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All weights provided for animals used in the CPE will be given in kilograms (kg).
Personnel Requirements
Personnel utilized for administration and scoring of the CPE must possess demonstrated expertise to test
entry-level clinical skills of veterinary graduates. The site and section coordinators and examiners must
possess well-founded knowledge of the list of common conditions/diseases and
pharmaceuticals/biologicals as they pertain to the practice of veterinary medicine in the United States
and Canada. Site coordinators should take precautions to ensure that potential ECFVG applicants are not utilized
to deliver the examination.
In order to assure adequate personnel, the following minimum standards are required:
Personnel must be provided as specified in the CPE Manual of Administration.
Four levels of personnel are identified. Each level must meet the minimum standards listed:
o Site Coordinator or equivalent—This person coordinates and manages the activities of the
examination site. They must have a DVM degree (or equivalent) with a minimum of five (5)
years clinical experience in a discipline representing one of the examination sections that
make up the CPE. Site Coordinators must also consistently attend CPE Site Coordinators
Meetings facilitated by the ECFVG and NEB.
o Section Coordinator or equivalent—This person organizes and sets up the specific section of
the examination and is responsible for the overall quality control and administration of that
section (see CPE Manual of Administration). Section Coordinators must have a DVM degree
(or equivalent) and been practicing in the section/discipline within the last 10 years, with a
minimum of five (5) years experience in the section/discipline.
o Examiner—This person coordinates and sets up the station with the Section Coordinator,
administers the station, and is directly responsible for evaluating the candidates. The
examiner also signs off as the primary examiner on all assessment sheets, even when a
secondary examiner or technician takes part in assessing a candidate’s performance.
Examiners must have a DVM degree (or equivalent) and been practicing in the
section/discipline within the last 10 years, with a minimum of two (2) years clinical
experience in the section/discipline. In addition, beginning in 2011, every examiner must
participate in an ECFVG (and/or NEB)-approved CPE examiners’ training session at least
one time every four years.
o Technical Assistant—This person assists the examiner(s) in monitoring the examination and
may assist in evaluating the candidates. He/She must possess training and expertise in the
species/procedure for which he/she is assisting. If the technical assistant is responsible for
assisting the examiner(s) in candidate evaluation, he/she must be under the direct supervision
of the examiner and have licensing, certification, or other documentation of expertise in that
section/discipline.
Facilities and Equipment
Candidates for the CPE are, in general, planning careers in clinical veterinary practice. The facilities
and equipment used in the CPE should meet contemporary practice standards for the US and/or Canada.
Facilities refer to structures and equipment refers to movable items used to practice clinical veterinary
medicine. The following are required:
Facilities and equipment used for the CPE must meet the requirements outlined in the CPE
Manual of Administration.
The facilities must assure the safety of personnel and candidates, and provide for the safety
and welfare of the animals.
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The facilities and equipment must be adequate to examine multiple candidates
simultaneously.
The facilities and equipment must comply with all relevant local, state, provincial and United
States or Canadian Federal regulations. These requirements include, but are not limited to
zoning, radiation safety, personnel and animal safety, animal care and use, and potentially
toxic or dangerous substances (anesthetic gases).
Because candidates are being evaluated on their ability to practice veterinary medicine at the
entry level of competence, physical facilities and equipment must simulate those used in a
United States or Canadian contemporary veterinary clinical facility.
Candidates for the examination must be provided with an adequate staging area for
orientation, storage, and rest.
All sites must provide timers, visible to all candidates, for each station or section. Whenever
possible, timers should be of the “count-down” variety to allow candidates and examiners
alike to clearly see time remaining in station or section.
Suggestions for Scheduling and Timing of the CPE
The seven-section CPE is designed to be administered in a three- to four-day period, with one to two
sections per day. Candidates can be split into two groups (Group A and Group B) for the purpose of
scheduling. Both the specific schedule and the number of candidates per group will vary among
examination sites.
Typically, sites will administer stations within a given section together such that candidates rotate (or
cycle) through the stations, often with a “break” station incorporated. However, sites have flexibility in
scheduling sections, and in particular, the single-station sections (NEC and RAD). Some sites may
administer these two sections together such that candidates rotate through these two sections, whereas
other sites may administer these sections separately or incorporated within another section. Likewise,
the Drug Protocol and Dose Calculation station of the Anesthesia section, which must be done before
beginning the rest of the Anesthesia section, may be administered as a stand-alone station, together with
the single-station sections (ie, NEC and RAD), or incorporated into another section (eg, Small Animal
Medicine). Candidates will be informed of the specific schedule used at their assigned site prior to the
start of their assigned CPE.
Regardless of the specific schedule used at each CPE site, the order in which the sections or stations are
administered is important. The following is a list of suggestions when preparing timetables.
1. The Drug Protocol and Dose Calculation Station should always be given at least one day
before the Anesthesia section, because each candidate will design anesthetic drug protocols
and calculate drug doses to be used within the Anesthesia Section assessment during this
station. Each site will need to determine how best to do this (eg, as a stand-alone station with
all candidates completing it at the same time, or as part of another section with candidates
rotating through the station).
2. The Surgery and Anesthesia sections must be scheduled concurrently, because Group A
candidates are performing surgery on animals that are being anesthetized by Group B
candidates and visa versa.
3. The Surgery and Anesthesia sections could be scheduled at least one day before the Necropsy
section if the animal used in these sections is to be euthanatized following surgery and used
for necropsy (please note that other species may be selected for necropsy; refer to the
Necropsy section for details).
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Other Policy Information
For other policy information specific to the CPE, ECFVG candidates are advised to contact the ECFVG
office (846-925-8070 or 800-248-2862, ext 6623 or 6682; ECFVG@avma.org;
www.avma.org/education/ecfvg/default.asp) and NEB candidates, the NEB office (613-236-1162, ext
116; mhollins@cvma-acmv.org; canadianveterinarians.net/about-programs-structure-examining.aspx).
CLINICAL PROFICIENCY EXAMINATION Anesthesia
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ANESTHESIA
A. Competencies
The Anesthesia Section will assess the candidate's ability to:
Select appropriate drugs and calculate correct doses (assessed within a stand-alone Drug
Protocol and Dose Calculation station)
Perform a preanesthetic examination to determine a patient’s anesthetic risk status
Select and use appropriate anesthetic equipment and accessories.
Premedicate, induce and maintain general anesthesia in a canine patient.
Monitor and assess a patient under general anesthesia
B. Time
Maximum time: Forty-five (45) minutes for the Drug Protocol and Dose Calculation Station;
one hundred (100) minutes (1 hour and 40 minutes) from start of the preoperative examination until the
patient is ready for surgical preparation (ie, all tasks outlined in the MOA are complete and the dog is
intubated and anesthetized with monitoring equipment and IV fluids in place and operational/running).
Candidates who exceed the 100 minute maximum for these activities/skills will be immediately
dismissed from, and receive a failing score for, this section of the CPE.
Once the surgical procedure begins, the Anesthesia candidate will continue to be assessed on the
maintenance phase of anesthesia and recovery of the patient. The Anesthesia assessment will terminate
with the conclusion of the ovariohysterectomy or immediately thereafter.
C. Set-up Information
1. Animal Requirements
The anesthesia candidate will utilize the animal designated for the surgery candidate (1 canine
animal per surgery candidate; animal weight provided in kilograms [kg])
2. People Requirements
a. For the Drug Protocol and Dose Calculation station
i. One proctor
b. For the rest of the Anesthesia section
i. One veterinary examiner per 3 candidates
ii. One technical assistant per 2 candidates
Section Coordinator or equivalent—This person organizes and sets up the specific section of the
examination and is responsible for the overall quality control and administration of that section (see CPE
Manual of Administration). Section Coordinators must have a DVM degree (or equivalent) and been
practicing in the section/discipline within the last 10 years, with a minimum of five (5) years experience
in the section/discipline.
Examiner—This person coordinates and sets up the station with the Section Coordinator, administers the
station, and is directly responsible for evaluating the candidates. The examiner also signs off as the
primary examiner on all assessment sheets, even when a secondary examiner or technician takes part
in assessing a candidate’s performance. Examiners must have a DVM degree (or equivalent) and been
practicing in the section/discipline within the last 10 years, with a minimum of two (2) years clinical
CLINICAL PROFICIENCY EXAMINATION Anesthesia
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experience in the section/discipline. In addition, beginning in 2011, every examiner must participate in
an ECFVG (and/or NEB)-approved CPE examiners’ training session at least one time every four years.
Technical Assistant—This person assists the examiner(s) in monitoring the examination and may assist
in evaluating the candidates. He/She must possess training and expertise in the species/procedure for
which he/she is assisting. If the technical assistant is responsible for assisting the examiner(s) in
candidate evaluation, he/she must be under the direct supervision of the examiner and have licensing,
certification, or other documentation of expertise in that section/discipline.
3. Facilities and Equipment–Facilities and Equipment for Anesthesia and Surgery are the same.
a. A room/area for the Drug Protocol and Dose Calculation station to allow candidates to
develop drug protocols and calculate doses
b. Rooms (or areas) equipped for the preparation of animals for surgery.
c. Rooms (or areas) equipped to carry out the required surgical procedure.
d. Timing device visible from each station to track elapsed examination time.
The facilities must assure the safety of personnel and candidates and provide for the safety and welfare
of the animals.
The facilities and equipment must be adequate to examine multiple candidates simultaneously.
The facilities and equipment must comply with all relevant local, state, provincial and United States or
Canadian Federal regulations. These requirements include, but are not limited to zoning, radiation
safety, personnel and animal safety, animal care and use, and potentially toxic or dangerous substances
(anesthetic gases).
Because candidates are being evaluated on their ability to practice veterinary medicine at the entry level
of competence, physical facilities and equipment must simulate those used in a United States or
Canadian contemporary veterinary clinical facility.
Candidates for the examination must be provided with an adequate staging area for orientation, storage,
and rest.
4. Supplies/Equipment/Accessories Provided By The Examiner
a. Standard anesthetic machines (each machine to have a precision halothane, isoflurane, or
sevoflurane vaporizer which is temperature and flow compensated and its own oxygen
supply; availability of specific vaporizer dependent on site of examination administration).
b. Circle or Bain System.
c. Standard anesthetic and monitoring accessories such as esophageal stethoscope, Doppler or
oscillometric blood pressure monitoring equipment (either one or the other will be provided,
dependent on CPE site), thermometer and/or electronic monitoring equipment, endotracheal
tube, laryngoscope (different blade sizes), intravenous catheters, IV fluids, pulse oximeter,
capnograph.
d. Scratch paper and nonprogrammable basic calculator for drug dose calculations.
5. Supplies Provided By The Candidate
a. Stethoscope, clean laboratory coat, surgical scrubs
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6. Specific Drug Requirements (Examiner will provide dosages of following drugs to candidates for
use on site in specific dose calculations; however, actual availability of specific drugs is
dependent on CPE site)
Acepromazine (0.01-0.15 mg/kg)
Atipamezole (equal volume to the volume of
of dexmedetomidine OR medetomidine
given)
Atropine (0.02-0.04 mg/kg)
Buprenorphine (10-20 mcg/kg [0.01-0.02
mg/kg]; not available in Canada)
Butorphanol (0.2-0.4 mg/kg)
Carprofen (4 mg/kg)
Diazepam (0.2-0.5 mg/kg)
Dexmedetomidine)(5-10 mcg/kg IM or 1-5
mcg/kg IV when used as a premedication
prior to induction of general anesthesia)
Glycopyrolate (0.005-0.01 mg/kg)
Halothane
Hydromorphone (0.05-0.2 mg/kg; not
available in Glasgow)
Isoflurane
Ketamine/diazepam (~5mg/kg/~0.2 mg/kg
[~1 ml/10 kg of a 1:1 v:v mix])
Medetomidine (2-10 mcg/kg [0.002-0.01
mg/kg])
Meloxicam (0.1-0.2 mg/kg)
Meperidine (3.5-5 mg/kg)
Midazolam (0.1-0.2 mg/kg)
Morphine (0.1-0.5 mg/kg)
Propofol (1-8 mg/kg)
Sevoflurane
Thiopental (5-20 mg/kg)
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D. Requirements of the Candidate
The Anesthesia and Surgery Sections of the CPE will be administered at the same time. The anesthesia
candidate will anesthetize, stabilize, and monitor the animal while the surgery candidate performs the
surgical procedure. Please note that the conditions pertaining to efficiency, as outlined on page 8 of the
Manual of Administration, will apply. In the event that an anesthesia or surgery candidate is unavailable
(eg, due to timetabling, number of candidates, etc), the examiner will provide a CPE team member to
perform the anesthesia and monitoring of the animal or the surgery.
If a candidate compromises his/her personal safety or the safety of personnel while working around
animals during the course of the Anesthesia Section, the examiner will intervene, may terminate the
procedure and will assign a penalty which will be reflected in the score. The entire Section may also be
scored as UNSATISFACTORY (ie, candidate will receive a failing score) depending on the nature of
the safety violation(s).
The examiner will assist an animal and terminate the Anesthesia Section if a candidate by an act of
omission or commission puts an animal into an inhumane or life threatening situation and the situation is
not corrected by the candidate (fatal flaws; please see Appendix 1 in the Anesthesia Section of the
MOA). Examples of life threatening situations include but are not limited to esophageal intubations that
are unrecognized and uncorrected by the candidate, failure to open pop-off valve, and failure to adjust
the depth of anesthesia to an appropriate level. Such errors may be considered fatal flaws. In the case of
a fatal flaw, the examiner will document and verify the error, correct it, and ask the candidate to leave
the Section immediately. The Anesthesia Section will be scored as UNSATISFACTORY (ie, candidate
will receive a failing score for the section) regardless of the score accumulated at the point of
termination.
The Anesthesia Section is scored as Pass or Fail. Candidates receiving a FAILING evaluation for any one
(1) MAJOR skill or any combination of four (4) MINOR skills as noted on the Anesthetic Skills
Assessment Sheet (AN01) may be allowed to complete this section but will receive a FAILURE for the
Anesthesia Section. Candidates committing a fatal flaw (see Appendix 1 in this section of the MOA) as
determined by the examiner will be immediately dismissed from, and will receive a failing score for, this
section of the CPE. Candidates must also note that there are many factors that go into the pass/fail
decision in this section. Successful entry-level performance of the skills assessed in the Anesthesia
Section involves much more than having the patient survive the anesthesia—in other words, more than
getting through the procedure without being dismissed for committing a fatal flaw.
Anesthetic Skills (AN01)
a. Selection of drugs/calculation of doses—Given the list of available drugs and recommended dose
ranges, the weight and estimated age of the canine patient, and assuming an ASA status of 1, the
candidate will design protocols for preanesthetic drugs, anesthesia induction, anesthesia
maintenance, and pain management; calculate doses for all drugs selected; and enter the results
on the form provided in Appendix 3 of the Anesthesia Section (Anesthesia Record). Please note:
candidates will complete this task during a maximum time period of 45 minutes sometime prior
to beginning the preanesthetic examination.
b. Preanesthetic examination—Given a female canine that is not obese (ie, weight appropriate for
breed [13–60 lbs or 6–27 kg in weight], not visibly or palpably pregnant, and not visibly in heat
(ie, no visible external evidence of bloody vaginal discharge), the candidate will conduct a
preoperative physical examination, to include at minimum an assessment of pulses,
cardiovascular status, and respiratory system; record the results of the preoperative
CLINICAL PROFICIENCY EXAMINATION Anesthesia
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examination; request appropriate minimum laboratory tests for the patient and procedure; review
and record results of minimum required laboratory tests, which will be provided by the
examiner; and assign an ASA preanesthetic physical status to the patient (see Appendix 2 of the
Anesthesia Section). All information is to be recorded on the form provided in Appendix 3 of the
Anesthesia Section (Anesthesia Record).
c. Selection and set-up of anesthetic equipment—Given the anesthetic supplies and equipment as
listed, the candidate will determine and record fresh gas flow rates for the patient; make
appropriate selections of other accessories (eg, endotrachael tube) as they relate to the patient;
choose and attach appropriate breathing system to machine, systematically check the
assembly and operation of the anesthetic equipment; and verbally explain or describe the
assembly and operation of the anesthetic equipment to the examiner.
d. Premedication and induction—Given a technical assistant, appropriate equipment, accessories,
and drugs prepared by the technical assistant or examiner in accordance with doses calculated by
the candidate, the candidate will premedicate and induce the animal to a surgical plane of
anesthesia. The candidate will record his/her reasons for selecting the specific drugs used on
the Anesthesia Record (Appendix 3 of the Anesthesia Section). Please note: doses were
calculated initially, assuming an ASA status of 1. However, if the actual ASA status based on the
candidate’s preanesthetic physical examination is different, then the candidate may modify the
actual doses administered based on the ASA status he/she determined immediately prior to
beginning the anesthetic procedure.
e. Patient monitoring and maintenance--The candidate will apply or place the following standard
monitoring equipment to the patient: blood pressure monitor, esophageal stethoscope,
thermometer, pulse oximeter, and capnograph; maintain and monitor the animal in a surgical
plane of anesthesia during the ovariohysterectomy; correct any abnormalities as assessed during
monitoring; interpret his/her assessment of patient parameters and monitoring equipment
readouts for that specific patient; be able to explain why corrections were or were not made; and
record necessary information on the anesthetic record provided in Appendix 3 of the Anesthesia
Section (Anesthesia Record).
See also AN01 Assessment on the following pages and Appendices 1-
CLINICAL PROFICIENCY EXAMINATION Anesthesia
Standard MOA 2012
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E. Anesthesia Final Score Sheet
AN01 ASSESSMENT, Anesthetic Skills PAGE 1
ACTIVITY/SKILL
Candidate is assessed on ability to correctly and
efficiently:
CANDIDATE SCORE (PASS [P] OR FAIL [F])
Note: a FAILING evaluation for any one (1) MAJOR skill
or any combination of four (4) MINOR skills will result in
a FAILURE for the Anesthesia Section. Candidates
committing a fatal flaw (see Appendix 1 in this section of
the MOA) will be immediately dismissed from, and will
receive a failing score for, this section of the CPE.
Select appropriate premedication, induction,
maintenance, and pain management drugs and
write rationale for choosing drugs
MINOR SKILL
Calculate the correct dose(s) of drug(s) selected
MAJOR SKILL
Perform and record results of a preoperative
examination on a patient presented for elective
ovariohysterectomy
MINOR SKILL
Request and record and interpret results of
minimum required laboratory tests
MINOR SKILL
Assign an appropriate preanesthetic physical
status to patient
MINOR SKILL
Determine appropriate fresh gas flow rates and
explain rationale for selecting a given rate for
the breathing system selected
MINOR SKILL FAILURE if candidate sets fresh gas flow
rate too high.
MAJOR SKILL FAILURE if candidate sets fresh gas flow
rate too low.
Select appropriate breathing system and
reservoir bag
MINOR SKILL
Select appropriate endotracheal tube and
laryngoscope (use optional)
MINOR SKILL
Select appropriate size and type IV catheter and
appropriate IV fluids
MINOR SKILL
Explain assembly of anesthetic machine and
breathing system and what is being checked
MINOR SKILL
Administer premedication in a manner that is
safe for the patient and personnel, and that
allows for actual delivery of the drug to the
patient.
MINOR SKILL FAILURE if candidate administers a low
dose.
MAJOR SKILL FAILURE if candidate administers a non-
lethal but high dose.
MAJOR SKILL FAILURE if candidate injects
premedication in the vicinity of a structure that might be
damaged.
AN01 continued on next page
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AN01 ASSESSMENT, Anesthetic Skill PAGE 2
ACTIVITY/SKILL
Candidate is assessed on ability to correctly and
efficiently:
CANDIDATE SCORE (PASS [P] OR FAIL [F])
Note: a FAILING evaluation for any one (1) MAJOR skill
or any combination of four (4) MINOR skills will result in
a FAILURE for the Anesthesia Section. Candidates
committing a fatal flaw (see Appendix 1 in this section of
the MOA) will be immediately dismissed from, and will
receive a failing score for, this section of the CPE.
Place an IV catheter and set up and administer
IV fluids
Note: If the candidate is unable to place the IV
catheter in three attempts, or if a correctly
placed catheter becomes dislodged following
placement, the examiner or a technician will
place the catheter and the candidate’s
assessment for this skill will be affected as
indicated in the right column. If a correctly
placed catheter is displaced as a result of a non-
candidate related issue, then the candidate’s
score may not be impacted.
PLACE IV CATHETER
TWO MINOR SKILL FAILURES if candidate is unable to
place the IV catheter in three attempts because of a
patient factor.
TWO MINOR SKILL FAILURES if candidate correctly
places the IV catheter in three attempts but it becomes
dislodged thereafter because he/she did not secure it
appropriately.
MINOR SKILL FAILURE if candidate has minor breaks in
asepsis during placement of IV catheter.
MAJOR SKILL FAILURE if candidate is unable to place
the IV catheter in three attempts because of poor
technique or inability to locate an appropriate vein.
IV FLUIDS
MINOR SKILL FAILURE if candidate does not connect
and administer IV fluids in an aseptic manner.
MINOR SKILL FAILURE if candidate sets an incorrect
fluid rate and animal’s health/life is not significantly
affected.
MAJOR SKILL FAILURE if candidate sets an incorrect
fluid rate and animal’s health/life is significantly and
negatively affected.
Induce and intubate patient
MAJOR SKILL
MINOR SKILL FAILURE if candidate fails to assess
catheter placement prior to injection of induction agent.
Connect patient to anesthetic machine, set
machine appropriately, and asses patient status
MAJOR SKILL
Place esophageal stethoscope
MINOR SKILL
Place/position Doppler or oscillometric blood
pressure monitor
MINOR SKILL
Place/position pulse oximeter
MINOR SKILL
Place/position capnograph
MINOR SKILL
Transfer patient to surgery area
MINOR SKILL
AN01 continued on next page
CLINICAL PROFICIENCY EXAMINATION Anesthesia Section
Standard MOA 2012
For use ONLY during calendar year 2012 22
AN01 ASSESSMENT, Anesthetic Skill PAGE 3
Change anesthetic machine settings as
necessary during the surgical procedure
MAJOR SKILL
Monitor/assess depth of anesthesia during the
surgical procedure
MAJOR SKILL
Monitor/assess patient’s cardiovascular status,
to include correcting any significant
abnormalities
MAJOR SKILL
Monitor/assess patient’s respiratory status, to
include correcting any significant abnormalities
MAJOR SKILL
Answer questions regarding specific values for
the patient from anesthetic or monitoring
equipment
MINOR SKILL
Completely and appropriately fill out anesthetic
record
MINOR SKILL
Overall efficiency of anesthetic procedure
MAJOR SKILL
Humane handling of patient
MAJOR SKILL
Ability to communicate with assistant(s)
MINOR SKILL
FINAL ANESTHESIA SECTION SCORE (PASS OR FAIL):
Comments regarding final score:
Primary examiner’s name/signature
Secondary examiner’s (or observer’s) name/signature (required only if fatal flaw observed):
CLINICAL PROFICIENCY EXAMINATION Anesthesia Section
Standard MOA 2012
For use ONLY during calendar year 2012 23
THIS PAGE INTENTIONALLY LEFT BLANK
Manual of Administration Anesthesia
Standard MOA 2012 Appendix 1
For use ONLY during calendar year 2012 24
F. Appendices
Appendix 1—Fatal Flaws
These are failing behaviors that potentially put the animal’s life at risk or personnel in danger. All are
behaviors that may require examiner intervention and will result in a failing grade for the candidate and
potential dismissal from this section of the CPE.
The examiner may stop the Anesthesia Section immediately if any one behavior from the following fatal
flaw list is observed (ie, recognized by the examiner and confirmed by another examiner or observer):
1. Candidate calculates and intends to administer a potentially lethal overdose of any drug.
2. Candidate fails to place the IV catheter correctly; attempts to place or places the IV catheter
in a non-aseptic manner; or commits gross breaks in asepsis during placement of the IV
catheter.
3. Candidate injects induction agent subcutaneously.
4. Candidate makes repeated unsuccessful attempts at intubation in an insufficiently
anesthetized dog (ie, a dog with active laryngeal reflexes). Candidate should be able to
intubate patient within five (5) minutes of initial administration of induction agent; failure to
do so is a fatal flaw.
5. Candidate places the endotracheal tube in the esophagus and fails to correct in a timely
fashion (ie, before dog wakes or becomes apparently hypoxic).
6. Candidate leaves the pop-off closed until pop-off valve pressure reads 25 cm H2O.
7. Candidate sets flow of oxygen at an insufficient level such that dog either awakens or
becomes apparently hypoxic.
8. Candidate maintains the patient at an excessive depth of anesthesia for an extended period of
time leading to loss of peripheral pulses (dorsal pedal or lingual pulse) or prolonged (eg, > 3
minutes) apnea.
9. Candidate fails to identify and correct a potentially life-threatening or inhumane situation
(eg, patient wakes up during the anesthesia section or during the surgical procedure and
candidate does not respond to situation; candidate does not attempt to correct problems
associated with major hemorrhage/hypovolemia).
10. Candidate fails to have the dog ready for the surgery candidate in the one hundred minute
time limit; “ready for surgery candidate” means all tasks outlined in the MOA are complete
and the dog is intubated and anesthetized with monitoring equipment (blood pressure
monitor, esophageal stethoscope, thermometer) and IV fluids in place and operating/running.
11. Candidate exhibits any other behavior that would put the dog’s life at risk. The examiner
must document the behavior.
Manual of Administration Anesthesia
Standard MOA 2012 Appendix 2
For use ONLY during calendar year 2012 25
Appendix 2—Preanesthetic Physical Status
American Society of Anesthesiologists (ASA) Classification System
ASA Status 1: Normal, healthy patient
ASA Status 2: Mild systemic disease, well compensated
ASA Status 3: Moderate systemic disease that is ongoing but compensated; some functional
limitations exist that increase the risk of anesthesia
ASA Status 4: Severe systemic disease that is a constant threat to life, uncompensated disease,
high anesthetic risk because vital body systems involved
ASA Status 5: Moribund patient not expected to live more than 24 hours with or without surgery
Manual of Administration Anesthesia
Standard MOA 2012 Appendix 3
For use ONLY during calendar year 2012 26
Appendix 3—Anesthesia Record
CPE DATE/SESSION/SITE:
CANDIDATE NAME/NUMBER:
DOG ID:
PRE-ANESTHETIC ASSESSMENT (candidate to write findings below unless otherwise noted)
PCV: MM color/CRT:
TP: HR:
Weight (to be filled in by examiner ahead of time): RR:
Temp (to be filled in by examiner ahead of time): Other relevant findings:
PRE-EXSISTING MEDICATION AND MEDICAL CONDITIONS (to be filled in by examiner ahead of time):
RELEVANT BLOOD CHEMISTRY RESULTS, IF ANY:
PREANESTHETIC PHYSICAL STATUS (as determined by candidate after completing preanesthetic
examination; circle one): 1 2 3 4 5
Write drug selections, dose calculations (mg or volume), route of administration, and time administered below:
Premed(s) Dose: Route: Time:
Dose: Route: Time:
Dose: Route: Time:
Induction agent(s) Dose: Route: Time:
Dose: Route: Time:
Dose: Route: Time:
Analgesics Dose: Route: Time:
Dose: Route: Time:
Dose: Route: Time:
Provide rationale for choosing the specific drugs (above) for your patient:
Manual of Administration Anesthesia
Standard MOA 2012 Appendix 3
For use ONLY during calendar year 2012 27
ANESTHESIA RECORD (Page 2)
CPE DATE/SESSION/SITE:
CANDIDATE NAME/NUMBER:
Circle appropriate number regarding sedation and induction of your patient, and provide comments as appropriate:
Scale: 1= very poor; 5= excellent
Sedation quality: 1 2 3 4 5
Induction quality: 1 2 3 4 5
Comments:
Circle inhalant anesthetic agent used:
Halothane Isoflurane Sevoflurane
Circle anesthetic machine type used
Circle Bain
Endotracheal tube used (write size):
Fresh gas flow rate used (write rate):
Candidate to complete all appropriate portions of anesthetic chart on next page. Request additional pages as needed.
Manual of Administration Anesthesia
Standard MOA 2012 Appendix 3
For use ONLY during calendar year 2012 28
ANESTHESIA RECORD (Page 3+ )
CPE DATE/SESSION/SITE:
CANDIDATE NAME/NUMBER:
Manual of Administration Anesthesia
Standard MOA 2012 Appendix 3
For use ONLY during calendar year 2012 29
ANESTHESIA RECORD (Page 4)
CPE DATE/SESSION/SITE:
CANDIDATE NAME/NUMBER:
(candidate to fill out each section below)
Complications noted and how corrected; if no complications noted, state so:
Fluids (write type used, flow rate, and total volume):
Recovery instructions, to include any instructions for use of analgesics:
Candidate Signature:
CLINICAL PROFICIENCY EXAMINATION Equine Practice
Standard MOA 2012
For use ONLY during calendar year 2012 30
EQUINE PRACTICE
A. Competencies
The equine portion will assess the candidate's ability to:
evaluate a clinical case (Station 1: Clinical Evaluation)
perform, and describe potential alternatives or explain purpose for, designated clinical
techniques (Station 2: Clinical Techniques)
evaluate lameness (Station 3: Lameness Evaluation)
B. Time
Maximum time, 2.25 hours (45 minutes per station)
C. Set-up Information
1. Animal Requirements
a. Station 1: Clinical Evaluation: One horse of mild temperament, sedated as necessary,
presented for clinical examination; the horse may or may not have abnormal clinical signs. If
a healthy horse is used, management advice will be sought on three of the following five
scenarios chosen by the examiner:
i. Feeding/housing
ii. Vaccination
iii. Deworming
iv. Dental care
v. Foot care
In order to provide variation in clinical examination case presentations at this station, a minimum
of two (2) horses and two clinical scenarios must be furnished (one shall be used for the morning
group of candidates and another for the afternoon group of candidates). Clinical cases used in a
CPE site examination may not be used at that site for three subsequent examinations.
b. Station 2: Clinical Techniques: One normal horse of mild temperament, sedated as necessary
c. Station 3: Lameness Evaluation: One horse that may be affected with a common lameness
(eg, American Association of Equine Practitioners [AAEP] Grade 3/5). Lameness must be
detectable at a trot in a straight line. In order to provide variation in lameness cases, a
minimum of two (2) horses must be furnished (one shall be used for the morning group of
candidates and another for the afternoon group of candidates). Clinical cases used in a CPE
site examination may not be used at that site for three subsequent examinations.
2. People Requirements
a. One veterinary examiner per candidate at each station.
b. One assistant per candidate as needed. Please note: assistant means an unskilled assistant.
Candidate must direct activity of the unskilled assistant. The examiner may act as an
unskilled assistant where appropriate.
Section Coordinator or equivalent—This person organizes and sets up the specific section of the
examination and is responsible for the overall quality control and administration of that section (see CPE
Manual of Administration). Section Coordinators must have a DVM degree (or equivalent) and been
practicing in the section/discipline within the last 10 years, with a minimum of five (5) years experience
in the section/discipline.
CLINICAL PROFICIENCY EXAMINATION Equine Practice
Standard MOA 2012
For use ONLY during calendar year 2012 31
Examiner—This person coordinates and sets up the station with the Section Coordinator, administers the
station, and is directly responsible for evaluating the candidates. The examiner also signs off as the
primary examiner on all assessment sheets, even when a secondary examiner or technician takes part
in assessing a candidate’s performance. Examiners must have a DVM degree (or equivalent) and been
practicing in the section/discipline within the last 10 years, with a minimum of two (2) years clinical
experience in the section/discipline. In addition, beginning in 2011, every examiner must participate in
an ECFVG (and/or NEB)-approved CPE examiners’ training session at least one time every four years.
Technical Assistant—This person assists the examiner(s) in monitoring the examination and may assist
in evaluating the candidates. He/She must possess training and expertise in the species/procedure for
which he/she is assisting. If the technical assistant is responsible for assisting the examiner(s) in
candidate evaluation, he/she must be under the direct supervision of the examiner and have licensing,
certification, or other documentation of expertise in that section/discipline.
3. Facilities and Equipment
a. 1 room/area for clinical evaluation station (Station 1)
b. 1 room/area for clinical techniques station (Station 2)
c. 1 area to evaluate a horse’s gait and to perform a lameness examination (Station 3)
d. Timing device visible from each station to track elapsed examination time.
The facilities must assure the safety of personnel and candidates, and provide for the safety and welfare
of the animals.
The facilities and equipment must be adequate to examine multiple candidates simultaneously.
The facilities and equipment must comply with all relevant local, state, provincial and United States or
Canadian Federal regulations. These requirements include, but are not limited to zoning, radiation
safety, personnel and animal safety, animal care and use, and potentially toxic or dangerous substances
(anesthetic gases).
Because candidates are being evaluated on their ability to practice veterinary medicine at the entry level
of competence, physical facilities and equipment must simulate those used in a United States or
Canadian contemporary veterinary clinical facility. Candidates for the examination must be provided
with an adequate staging area for orientation, storage, and rest.
4. Supplies/Information Provided by the Examiner
The following supplies and information will be provided by the examiner, as appropriate, for
each station within the Equine Practice section:
a. Halter, lead rope, lead shank, assorted twitches, towels, tape measure.
b. Assortment of needles, syringes, vacutainers and disinfectants (alcohol, chlorhexidine, etc),
gauze sponges.
c. Assorted dental rasps (floats), assorted mouth gags and speculae, flashlight.
d. Assorted nasogastric tubes, lubricant, bucket, mineral oil, funnel, dose syringe, stomach
pump.
e. Assorted bandages.
f. Injectable saline, assorted sedatives and dosages (xylazine, acepromazine, detomidine,
romifidine, etc)
g. Rebreathing bag, plexor, pleximeter, ophthalmoscope
CLINICAL PROFICIENCY EXAMINATION Equine Practice
Standard MOA 2012
For use ONLY during calendar year 2012 32
h. Hoof pick, left- and right-handed hoof knives, assorted hoof testers
5. Supplies Provided By The Candidate
a. Stethoscope, digital rectal thermometer, penlight, coveralls, safety boots (ie, appropriate
footwear for equine work).
Other items necessary to perform examination will be provided by examiner
CLINICAL PROFICIENCY EXAMINATION Equine Practice
Standard MOA 2012
For use ONLY during calendar year 2012 33
D. Requirements of the Candidate
If a candidate compromises his/her personal safety or the safety of personnel while working around
animals during the Equine Practice Section, the examiner will intervene, may terminate the procedure,
and will assign a penalty that will be reflected in the number of points assigned to the particular skill.
The section may also be scored as UNSATISFACTORY depending on the nature of the safety
violation(s). If a candidate puts him/herself or any other personnel in immediate danger either by an act
of commission or omission, the examiner will take immediate corrective action and terminate the Equine
Practice Section. The entire section will be scored as UNSATISFACTORY regardless of the score
accumulated at the point of termination.
The examiner will assist an animal and terminate the Equine Practice Section if a candidate by an act of
omission or commission puts an animal into an inhumane or life threatening situation and the situation
is not corrected by the candidate. The entire section will be scored as UNSATISFACTORY regardless
of the score accumulated at the point of termination.
Station 1–Clinical Evaluation
Given a horse of mild temperament (sedated if necessary) in a box stall, a person acting as an
‘unskilled’ assistant, and a halter, lead rope and lead shank, the candidate will catch the horse. If
assistance is needed, the unskilled assistant can provide assistance, but ONLY according to the
candidate’s direction
Given the above assistant, again, acting on instruction from the candidate, the candidate will:
restrain the horse; question the client/examiner in order to obtain a history; perform a
complete physical examination; compile a problem list, or, if no problems are identified,
address the client examiner’s management question; indicate which body systems may be
involved; compile a differential diagnoses list; select from this list the most likely diagnosis;
develop diagnostic and therapeutic plans; state any regulatory and public health concerns if
appropriate; and explain any problems or address management issues to the client/examiner.
When required and requested by the candidate, standard laboratory data for appropriate
diagnostic tests will be provided in written form with normal values.
Note: See also sample EQ01 assessment sheet on following pages
CLINICAL PROFICIENCY EXAMINATION Equine Practice
Standard MOA 2012
For use ONLY during calendar year 2012 34
EQ01 ASSESSMENT (clinical evaluation)
PAGE 1
Activity/Skill
MAX
POINTS
CANDIDATE
SCORE
Restraint and safety
Can involve the following competencies:
5
a. Ability to instruct unskilled assistant on appropriate and safe
handling techniques
b. Ability to approach horse in an appropriate manner
c. Ability to place halter on horse correctly
d. Ability to instruct on the use of and/or use appropriate manual
restraint (eg, twitch, ear hold, lip chain, etc)
e. Ability to instruct on the administration of and/or explain need
for and/or administer appropriate chemical restraint
History taking
Can involve elicit the following competencies from client/examiner:
20
a. Signalment, including breed
b. Presenting complaint or reason for evaluation
c. Duration of presenting complaint or management issues
d. Past problems, including previous treatments and response to
those treatment
e. Extent of involvement of other animals on premises
f. Housing
g. Medication history
h. Vaccination history
i. Dietary/nutrition history
j. Intended use of animal presented for evaluation
Physical examination
Attention to personal/professional hygiene will be evaluated (eg, use
of clean instruments, washing hands when appropriate, discarding
used equipment/supplies appropriately)
Can involve the following competencies:
33
a. Performing distance examination, including body condition
b. Performing complete and appropriate (for the case) hands-on
examination
c. Accurately interpret results of rectal examination, if appropriate and
relevant to the case.
EQ01 continued on next page
CLINICAL PROFICIENCY EXAMINATION Equine Practice
Standard MOA 2012
For use ONLY during calendar year 2012 35
EQ01 ASSESSMENT (clinical evaluation)
PAGE TWO
Activity/Skill
MAX
POINTS
CANDIDATE
SCORE
Integration
Candidate will be assessed on ability to develop diagnostic and
therapeutic plan OR identify and provide solutions of management
issues
Competencies to include:
30
a. Developing problem (significant findings) list, differential
diagnoses, and most likely diagnosis OR identifying potential
problems with current management procedures
b. Developing diagnostic/management plan
Communication
Can involve the following competencies:
12
a. Communicating therapeutic or management plan for
individual animal to client
b. Communicating therapeutic or management plan for herd, if
appropriate, to client
c. Communicating prognosis
d. Discussing prevention and control issues
e. Discussing management issues
f. Discussing public health issues TOTAL POINTS
100
CLINICAL PROFICIENCY EXAMINATION Equine Practice
Standard MOA 2012
For use ONLY during calendar year 2012 36
D. Requirements of the Candidate
Station 2–Clinical Techniques
Given a horse of common physical characteristics, the candidate will perform the three (3)
following standard (indicated by asterisks) and five (5) of the remaining nine (without asterisks)
randomly-selected skills:
1. Describe the horse for the purpose of positive identification for equine infectious anemia
(EIA) testing, insurance examination, or interstate health certificates, as directed by the
examiner.
2. Identify usual IM, IV, and SQ injection sites and perform an intravenous and
intramuscular injection, using injectable saline†. Select from one of the following drugs
and discuss injection volume, method of injection, and possible complications: xylazine,
phenylbutazone, procaine penicillin, banamine (flunixin meglumine), acepromazine.***
3. Given an assortment of needles, syringes, vacutainers, swabs and disinfectants, take a
blood sample for testing for equine infectious anemia (EIA), serum biochemistry
analysis, or complete blood count (CBC) as directed by the examiner, using the
appropriate vacutainer(s) for a stated laboratory test(s).
4. Perform an examination of the oral cavity, estimate the age of the horse, discuss and
perform the rasping (floating) of the upper cheek teeth, using manual tools. Manual
restraint or light sedation may be used at the examiner’s discretion.
5. Place a support (aka standing, shipping, or stable) bandage on a forelimb.
6. Discuss how to safely perform a rectal examination.
7. Discuss how to perform a complete ophthalmic examination (ie, with nerve blocks) OR
perform a basic ophthalmic examination, using a direct scope (decision on whether to
discuss a complete exam or perform a basic exam is at the examiner’s discretion).
8. Describe how to safely collect an endometrial swab (mares only).
9. Describe how to place a jugular catheter, but do not actually place it.
10. Describe how to place a nasogastric tube, including selection of tube and lubricant.***
11. Describe how to perform abdominocentesis, including selection of needles/tubes.
12. Completely auscultate the thorax (cardiorespiratory system), using a rebreathing bag.***
Note: See also sample EQ02 assessment sheet on following page
CLINICAL PROFICIENCY EXAMINATION Equine Practice
Standard MOA 2012
For use ONLY during calendar year 2012 37
EQ02 ASSESSMENT (Clinical techniques)
PAGE ONE
Activity/Skill
MAX
POINTS
CANDIDATE
SCORE
Candidate is scored on ability to correctly and efficiently perform the
three (3) following standard (indicated by asterisks) and five (5) of
the remaining nine (without asterisks) randomly-selected skills:
i. Describe horse for the purpose of positive identification for EIA (equine
infectious anemia) testing, insurance examination, or interstate health
certificates as directed by the examiner.
11
ii. Identify usual IM, IV, and SQ injection sites, AND***
15
a. Perform an intravenous and intramuscular injection, using
injectable saline, AND
b. Discuss injection volumes, method of injection, and possible
complications of one of the following drugs, which will be
randomly selected by the examiner: xylazine, phenylbutazone,
procaine penicillin, banamine (flunixin meglumine),
acepromazine
iii. Take blood sample, to include selection of correct needles and blood
tube, for testing for equine infectious anemia (EIA), serum biochemistry
analysis, or complete blood count (CBC), as directed by examiner.
11
iv. Examine oral cavity, AND 11
a. Estimate age, AND
b. Discuss and briefly perform rasping (floating) of upper cheek
teeth
v. Place a support (aka standing, shipping, or stable) bandage on a
forelimb
11
vi. Discuss how to safely perform a rectal examination 11
vii. Discuss how to perform a complete ophthalmic examination OR
perform a basic ophthalmic examination, using a direct scope
11
viii. Describe how to safely collect an endometrial swab (mares only) 11
ix. Describe how to place a jugular catheter 11
x. Describe how to place a nasogastric tube, including selection of
tube and lubricant***
15
xi. Describe how to perform abdominocentesis, including selection
of needles/tubes
11
xii. Completely auscultate the thorax (cardiorespiratory system),
using a rebreathing bag***
15
TOTAL POINTS
100
CLINICAL PROFICIENCY EXAMINATION Equine Practice
Standard MOA 2012
For use ONLY during calendar year 2012 38
D. Requirements of the Candidate
Station 3–Lameness Evaluation
In this station, the candidate, given a horse with a common lameness and an assistant to handle
the horse, will obtain a history from the client/examiner and perform an initial examination to
characterize the horse’s lameness/gait abnormality (eg, observation at a walk and trot). The
candidate will explain why he/she has diagnosed the lameness in a particular limb. The
candidate should also briefly discuss appropriate general principles related to equine lameness
(eg, how to differentiate fore-vs hind-limb lameness and proximal limb vs distal limb
abnormalities) and will identify five randomly selected and readily palpable anatomical
structures from the following list (eg, cannon bone, splint bones, fetlock joint pouches,
suspensory ligament, deep digital flexor tendon, superficial digital flexor tendon, central sulcus
of frog, scapulohumeral joint, accessory carpal bone, olecranon, calcaneus, patella, medial
patellar ligament, coxofemoral joint, greater trochanter, carpus/tarsus, tuber ischii, tuber sacrale,
tuber coxae, point of shoulder, semitendinosus/semimembranosus muscles).
The sites have the option of allowing individual observation of the lame horse in motion or group
observation. If individual observation is used, that observation occurs within the 45 minutes
schedule for the lameness station. If group observation is used, the group observation should be
limited to 10 minutes, with the remaining 35 minutes allocated to the lameness station for each
individual candidate. With either option, a total of 45 minutes is the time limit to complete all
tasks.
The candidate will systematically examine the affected limb in order to localize the problem.
Please note: to receive points, the candidate must have selected the actual affected limb; that is,
the actual limb on which the patient is lame. Such an examination should usually include:
characterization of digital pulses, picking up and cleaning the foot, examination with hoof
testers, detailed palpation of the limb, and manipulation of joints. The candidate will perform an
appropriate flexion test and discuss associated principles, or will justify why a flexion test is not
appropriate. The candidate will request appropriate nerve and/or joint blocks for the specific
case, or will justify why nerve and/or joint blocks are not appropriate. In addition, regardless of
the case, the candidate will describe and discuss how to perform palmar/plantar digital, abaxial
sesmoid, and low and high volar nerve blocks on the affected limb and associated principles (eg,
landmarks, preparation, technique, desensitized areas, etc). The candidate will not perform
imaging examinations (ie, will not obtain images themselves), but will indicate what types of
imaging examinations are appropriate for the specific case. If the candidate believes no imaging
is required, he/she will justify that decision.
The examiner will provide results of diagnostic tests (to include radiography and nerve/joint
blocks) recommended by the candidate. Results of those tests completed will be provided by the
site in written or hard copy form (either digital or film radiographic studies are acceptable) with
normal values (if appropriate; eg, for hematological tests but not for radiographs). The candidate
will then formulate a conclusion regarding the affected anatomical region leading to lameness
and communicate the source of the lameness and the short- and long-term prognoses for return to
intended use to the examiner.
Note: See also sample EQ03 assessment sheet on following pages
CLINICAL PROFICIENCY EXAMINATION Equine Practice
Standard MOA 2012
For use ONLY during calendar year 2012 39
EQ03 ASSESSMENT (lameness evaluation)
PAGE 1
Activity/Skill MAX
POINTS
CANDIDATE
SCORE
History
Candidate is assessed on ability to elicit following from client (examiner): 5
a. Signalment, including breed
b. Presenting complaint
c. Duration of presenting complaint
d. Previous treatment(s); response to those treatments
e. Intended use of affected animal
Initial Characterization of Lameness Based on Walk/Trot
Candidate is assessed on ability to:
15
a. Describe head or hip position in relation to stride (fore vs. hind limb)
b. Describe normal/abnormal parts of stride (to include at a minimum
landing, length, sound symmetry)
c. Explain his/her reasons for diagnosing the lameness in a specific limb in
the patient provided
Lameness Examination
Candidate is assessed on ability to perform a systematic examination of the
actual affected limb, to include at a minimum: 65
a. Characterization of digital pulses
b. Picking up, examining the foot, and applying hoof testers
c. Detailed palpation of the limb for identification of effusions and swellings,
heat and pain
d. Manipulation of joints
e. Performance of appropriate flexion test(s), or justification for not
performing
f. Describing how to do plamar/plantar digital, abaxial sesmoid, and low
and high volar nerve blocks
g. Requesting appropriate nerve/joint blocks, or justification for not
requesting
h. Requesting appropriate radiographic imaging, or justification for not
requesting
i. Correctly identifying affected anatomical region
j. Communicating short and long-term prognosis for return to intended use
EQ03 continued on next page
CLINICAL PROFICIENCY EXAMINATION Equine Practice
Standard MOA 2012
For use ONLY during calendar year 2012 40
EQ03 ASSESSMENT (lameness evaluation)
PAGE 2
Activity/Skill MAX
POINTS
CANDIDATE
SCORE
Palpation
Candidate is assessed on ability to correctly identify five of the following 20
structures randomly selected by the examiner: 15
a. Cannon bone (MC III)
b. Splint bones (MC II and MC IV)
c. Fetlock joint pouches (metacarpal-phalangeal joint)
d. Suspensory ligament
e. Superficial digital flexor/deep digital flexor tendon
f. Central sulcus of the frog
g. Scapulohumeral joint
h. Accessory carpal bone
i. Olecranon
j. Calcaneus
k. Patella
l. Medial patellar ligament
m. Coxofemoral joint
n. Greater trochanter
o. Carpus or tarsus
p. Tuber ischii
q. Tuber sacrale
r. Tuber coxae
s. Point of shoulder
t. Semitendinosus/semimembranosus muscles
TOTAL POINTS
100
CLINICAL PROFICIENCY EXAMINATION Equine Practice
Standard MOA 2012
For use ONLY during calendar year 2012 41
E. Equine Practice Summary and Final Score Sheet
EQ04 SCORE SHEET, Equine Practice
Date:
Name Of Candidate:
POINTS
WEIGHTING
WEIGHTED
POINTS 1. Clinical Evaluation, EQ01
35%
2. Clinical Techniques, EQ02
35%
3. Lameness Evaluation, EQ03
30%
FINAL POINTS
100%
CLINICAL PROFICIENCY EXAMINATION Food Animal Practice
Standard MOA 2012
For use ONLY during calendar year 2012 42
FOOD ANIMAL PRACTICE
A. Competencies
The food animal practice portion will assess the candidate's ability to:
evaluate an adult bovine (> 6 months of age) clinical case, including evaluation of herd
health and regulatory issues (Station 1: clinical case, bovine station)
evaluate a bovine calf (< 6 months of age) or a caprine or ovine clinical case, including
evaluation of herd health and regulatory issues (Station 2: clinical case, other food animal
station)
perform designated clinical skill procedures (Station 3: clinical procedures station)
perform bovine reproductive procedures (Station 4: bovine theriogenology and public
health, food safety, and regulatory issues station)
list drugs prohibited for extralabel use in food animals in the United States or Canada
(Station 4: bovine theriogenology and public health, food safety, and regulatory issues
station)
B. Time
Maximum time, 3 hours (break down of time given below; candidates will NOT be allowed additional
time for any station)
1. Clinical case, bovine station: 45 minutes maximum
2. Clinical case, other food animal station: 45 minutes maximum
3. Clinical procedures station: 2 areas; total time: 45 minutes maximum
4. Bovine theriogenology and public health, food safety, and regulatory issues station: 3 areas; total
time for Area A: 10 minutes maximum (5 minutes for rectal palpation): total time for Areas B
and C combined: 35 minutes maximum
C. Set-up Information
1. Animal Requirements
a. Case stations
i. Station 1—One bovine animal > 6 months of age.
ii. Station 2—One bovine animal < 6 months of age OR one ovine OR one caprine animal.
In order to provide variation in clinical case presentations at each clinical station, a minimum of
two (2) clinical cases must be furnished (one shall be used for the morning group of candidates
and another for the afternoon group of candidates) for each of Stations 1 and 2. Clinical cases
used in a CPE site examination may not be used at that site for three subsequent examinations.
b. Procedures station
i. Station 3—One lactating dairy cow.
c. Bovine theriogenology and public health, food safety, and regulatory issues station
i. Station 4, Part A—One sexually mature cow.
2. People Requirements
a. Clinical case, bovine station (Station 1): One veterinary examiner per candidate (45 minutes).
b. Clinical case, other food animal station (Station 2): One veterinary examiner per candidate
(45 minutes).
c. Clinical procedures station (Station 3): One veterinary examiner per candidate (45 minutes).
d. Bovine theriogenology and public health, food safety, and regulatory issues station (Station
4): One veterinary examiner per candidate (45 minutes).
CLINICAL PROFICIENCY EXAMINATION Food Animal Practice
Standard MOA 2012
For use ONLY during calendar year 2012 43
Section Coordinator or equivalent—This person organizes and sets up the specific section of the
examination and is responsible for the overall quality control and administration of that section (see CPE
Manual of Administration). Section Coordinators must have a DVM degree (or equivalent) and been
practicing in the section/discipline within the last 10 years, with a minimum of five (5) years experience
in the section/discipline.
Examiner—This person coordinates and sets up the station with the Section Coordinator, administers the
station, and is directly responsible for evaluating the candidates. The examiner also signs off as the
primary examiner on all assessment sheets, even when a secondary examiner or technician takes part
in assessing a candidate’s performance. Examiners must have a DVM degree (or equivalent) and been
practicing in the section/discipline within the last 10 years, with a minimum of two (2) years clinical
experience in the section/discipline. In addition, beginning in 2011, every examiner must participate in
an ECFVG (and/or NEB)-approved CPE examiners’ training session at least one time every four years.
3. Facilities and Equipment
a. 2 rooms/areas for restraining food animals (case presentations; Stations 1 and 2)
b. 1 room/area for restraining a bovine animal (procedures station; Station 3)
c. 1 room/area for restraining a bovine animal, placing an obstetric box, and writing a brief list
(bovine theriogenology and public health, food safety, and regulatory issues station; Station
4)
d. Timing device visible from each station to track elapsed examination time.
The facilities must assure the safety of personnel and candidates, and provide for the safety and welfare
of the animals.
The facilities and equipment must be adequate to examine multiple candidates simultaneously.
The facilities and equipment must comply with all relevant local, state, provincial and United States or
Canadian Federal regulations. These requirements include, but are not limited to zoning, radiation
safety, personnel and animal safety, animal care and use, and potentially toxic or dangerous substances
(anesthetic gases).
Because candidates are being evaluated on their ability to practice veterinary medicine at the entry level
of competence, physical facilities and equipment must simulate those used in a United States or
Canadian contemporary veterinary clinical facility.
Candidates for the examination must be provided with an adequate staging area for orientation, storage,
and rest.
4. Supplies/Information Provided By The Examiner
a. Bucket, water, towels, halter, mouth gag, nose tongs, stomach tube
b. Speculum, lubricant, container for ruminal fluid
c. Milk sample collection vials (for bacterial culture), milk sample
d. CMT (California Mastitis Test) paddle solution/reagent, assorted vacutainers
e. Container for urine sample, urine test sticks, product information and references, clipboard
f. Rectal gloves and other gloves, standard bovine obstetrical equipment
CLINICAL PROFICIENCY EXAMINATION Food Animal Practice
Standard MOA 2012
For use ONLY during calendar year 2012 44
5. Supplies Provided By The Candidate
a. Stethoscope, digital thermometer, and penlight
b. Coveralls and disinfectable footwear
CLINICAL PROFICIENCY EXAMINATION Food Animal Practice
Standard MOA 2012
For use ONLY during calendar year 2012 45
D. Requirements of the Candidate
If a candidate compromises his/her personal safety or the safety of personnel while working around
animals during the Food Animal Practice section of the CPE, the examiner will intervene, may
terminate the procedure and will assign a penalty which will be reflected in the number of points
assigned to the particular skill. The Food Animal Practice section may also be scored as
UNSATISFACTORY depending on the nature of the safety violation(s).
The examiner will assist an animal and terminate the Food Animal Practice section if a candidate by an
act of omission or commission puts an animal into an inhumane or life-threatening situation and the
situation is not corrected by the candidate. The entire section will be scored as UNSATISFACTORY
regardless of the score accumulated at the point of termination.
Station 1–Clinical Case, Bovine
Given a bovine animal > 6 months of age, of mild temperament (sedated if necessary), restrained
in a chute or stocks, affected with a clinical condition commonly found in the industry, the
candidate will question the examiner/client in order to obtain a history; perform a physical
examination, including distance and hands-on examination; compile a problem list and a
differential diagnoses list; select from the differential diagnoses list the most likely diagnosis;
develop diagnostic, therapeutic, and control plans for the individual animal and the herd where
appropriate; state the regulatory and public health implications; and explain the problem and
follow-up care to the client/examiner. Examiners may also ask the candidate to record his/her
findings in writing.
When required and requested by the candidate, standard laboratory data for appropriate
diagnostic tests will be provided in written form with normal values
Note—See also example FAP01 assessment sheet on the following pages.
Note—The candidate may request pertinent laboratory data from the examiner in conjunction with the
above case. The examiner will provide results of only those tests completed.
CLINICAL PROFICIENCY EXAMINATION Food Animal Practice
Standard MOA 2012
For use ONLY during calendar year 2012 46
FAP01 ASSESSMENT (clinical case, bovine station)
PAGE 1
ACTIVITY/SKILL MAX
POINTS
CANDIDATE
SCORE
History taking
Can involve eliciting the following from client/examiner:
20
a. Signalment, including breed
b. Presenting complaint
c. Duration of presenting complaint
d. Previous treatment(s); response to those treatments
e. Past problems
f. Extent of involvement of other animals on premises
g. Reproductive phase of affected animal
h. Production phase of affected animal (eg, for dairy)
i. Vaccination history
j. Nutrition history
Physical examination
Attention to personal/professional hygiene will be evaluated (eg, use of clean
instruments, washing hands when appropriate, discarding used
equipment/supplies appropriately)
Can involve the following competencies:
30
a. Performing distance examination, including body condition
b. Performing hands-on examination
c. Interpreting results of rectal examination, if appropriate for the case
Note: discussion only with the examiner, rectal examination NOT performed
by candidate
Developing problem list, differential diagnoses, and most likely
diagnosis
Can involve the following competencies:
15
a. Identification of all problems
b. Developing rational differential diagnoses list
c. Arriving at the most likely diagnosis
Developing diagnostic plan Note: points will be deducted for developing a correct diagnostic plan for a
set of differentials that does not include the correct diagnosis. Maximum
points awarded for developing a diagnostic plan for a set of differentials that
does not include the correct diagnosis is 60% of total points allowed for this
skill/activity (ie, 15 points).
Can involve the following competencies:
25
a. Ordering appropriate diagnostic tests and/or necropsy
b. Interpreting laboratory and/or necropsy results
FAP01 continued on next page
CLINICAL PROFICIENCY EXAMINATION Food Animal Practice
Standard MOA 2012
For use ONLY during calendar year 2012 47
FAP01 ASSESSMENT (clinical case, bovine station)
PAGE 2
ACTIVITY/SKILL
MAX
POINTS
CANDIDATE
SCORE
Developing therapeutic plan and communication ability
Note: points will be deducted for developing and communicating a correct
therapeutic plan for a set of differentials that does not include the correct
diagnosis. Maximum points awarded for developing a correct therapeutic
plan for a set of differentials that does not include the correct diagnosis is
60% of total points allowed for this skill/activity. (ie, 6 pts).
Can involve the following competencies:
10
a. Developing/communicating therapeutic plan for individual animal
b. Developing/communicating therapeutic plan for herd
c. Developing/communicating prognosis
d. Discussing prevention and control issues
e. Discussing regulatory issues, public health issues, and food
safety/slaughter for food issues
TOTAL POINTS
100
CLINICAL PROFICIENCY EXAMINATION Food Animal Practice
Standard MOA 2012
For use ONLY during calendar year 2012 48
D. Requirements of the Candidate
Station 2–Clinical Case, Other Food Animal
Given a bovine animal < 6 months of age or an ovine or caprine animal of any age affected with
a clinical condition commonly found in the industry, the candidate will question the
client/examiner in order to obtain a history; perform a physical examination, including distance
and hands-on examination; compile a problem list and a differential diagnoses list; select from
the differential diagnoses list the most likely diagnosis; develop diagnostic, therapeutic, and
control plans for the individual animal and the herd where appropriate; state the regulatory and
public health implications; and explain the problem and follow-up care to the client/examiner.
Examiners may also ask the candidate to record his/her findings in writing.
When required and requested by the candidate, standard laboratory data for appropriate
diagnostic tests will be provided in written form with normal values.
Note—See also example FAP02 assessment sheet on the following pages.
Note—The candidate may request pertinent laboratory data from the examiner in conjunction with the
above case. The examiner will provide results of only those tests completed.
CLINICAL PROFICIENCY EXAMINATION Food Animal Practice
Standard MOA 2012
For use ONLY during calendar year 2012 49
FAP02 ASSESSMENT (clinical case, other food animal station)
PAGE 1
ACTIVITY/SKILL Max
Points
Candidate
Score
History taking
Can involve the following from client/examiner:
20
a. Signalment, including breed
b. Presenting complaint
c. Duration of presenting complaint
d. Previous treatment(s); response to those treatments
e. Past problems
f. Extent of involvement of other animals on premises
g. Reproductive phase of affected animal
h. Production phase of affected animal
i. Vaccination history
j. Nutrition history
k. Intended use of affected animal
Physical examination
Attention to personal/professional hygiene will be evaluated (eg, use of
clean instruments, washing hands when appropriate, discarding used
equipment/supplies appropriately)
Can involve the following competencies:
30
a. Assigning a body condition score
b. Performing distance examination
c. Performing hands-on examination
Developing problem list, differential diagnoses, and most likely
diagnosis
Can involve the following competencies:
15
a. Identification of all problems
b. Developing rational differential diagnoses list
c. Arriving at the most likely diagnosis
Developing diagnostic plan
Note: points will be deducted for developing a correct diagnostic plan for a
set of differentials that does not include the correct diagnosis. Maximum
points awarded for developing a correct diagnostic plan for a set of
differentials that does not include the correct diagnosis is 60% of total
points allowed for this skill/activity (ie, 15 points). Points will also be
deducted for requesting unnecessary diagnostic tests.
Can involve the following competencies:
25
a. Ordering appropriate diagnostic tests and/or necropsy
b. Interpreting laboratory and/or necropsy results
FAP02 continued on next page
CLINICAL PROFICIENCY EXAMINATION Food Animal Practice
Standard MOA 2012
For use ONLY during calendar year 2012 50
FAP02 ASSESSMENT (clinical case, other food animal station)
PAGE 2
ACTIVITY/SKILL Max
Points
Candidate
Score Developing therapeutic plan and communication ability
Note: points will be deducted for developing and communicating a correct
therapeutic plan for a set of differentials that does not include the correct
diagnosis. Maximum points awarded for developing a correct therapeutic
plan for a set of differentials that does not include the correct diagnosis is
60% of total points allowed for this skill/activity. (ie, 6 pts).
Can involve the following competencies:
10
a. Developing/communicating therapeutic plan for individual animal
b. Developing/communicating therapeutic plan for herd
c. Developing/communicating prognosis
d. Discussing prevention and control issues
e. Discussing regulatory issues, public health issues, and food
safety/slaughter for food issues
TOTAL POINTS
100
CLINICAL PROFICIENCY EXAMINATION Food Animal Practice
Standard MOA 2012
For use ONLY during calendar year 2012 51
D. Requirements of the Candidate
Station 3–Clinical Procedures
Part A: Given a mature lactating cow of mild temperament (sedated if necessary) and
adequately restrained in a chute or stocks, the examiner will ask the candidate to perform the
following procedures in order:
1. Prepare the udder of the cow for routine milking
2. Obtain a milk sample from each quarter, perform a California Mastitis Test (CMT) on the
sample from each quarter, and interpret the test results.
3. Obtain a milk sample for bacterial culture, interpret bacterial culture results, which will
be provided, and provide a therapeutic plan for the dairyman consistent with the culture
results provided.
4. Correctly place a halter on the cow and restrain the cow safely and humanely to allow
procedures, such as insertion of an intravenous catheter, to be performed on the head and
neck.
Note—See also example FAP03 assessment sheet on the following page.
Note—If any procedure is causing unreasonable discomfort or danger to the animal, the examiner will
intervene, may terminate the procedure, and will assign a penalty, which will be reflected in the number
of points assigned to the particular skill.
Part B: Using the same, or another similar cow as in Part A, the candidate will perform five (5)
procedures from the following list. Two (2) procedures will be randomly chosen from skills 1-4;
three (3) procedures will be randomly chosen from skills 5-15.
1. Place a mouth gag and perform an examination of the oral cavity.
2. Pass a stomach tube, ensure it is placed correctly, and collect rumen fluid.
3. Select the appropriate vacutainer, collect a blood sample by coccygeal venipuncture.
4. Manually collect urine sample, describe sample, perform a gross assessment and dipstick
test, interpret results (including limitations of dipstick).
5. Perform abomasal/rumen gas cap identification test, discuss how to differentiate between
rumen gas cap, ping of a left displaced abomasum, and pneumoperitoneum,
pneumorectum, or pneumocolon.
6. Demonstrate how to insert an intravenous catheter into the jugular vein.
7. Demonstrate how to perform an epidural injection.
8. Describe how to examine a hind foot for suspected foot lameness.
9. Perform a speculum examination, to include prepping the vulva, to evaluate cervix.
10. Identify where and explain how to inject one of the following drugs: oxytetracycline,
florfenicol, or ceftifour.
11. Demonstrate a common and easy method to restrain animal to allow examination of, or
administration of treatment to, the hindquarters (eg, tail jack).
12. Perform a withers pinch test (ie, grunt test).
13. Identify site for, and describe how to perform, cornual nerve block.
14. Demonstrate paravertebral anesthesia.
15. Administer oral medication.
Note—If any procedure is causing unreasonable discomfort or danger to the animal, the examiner will
intervene, may terminate the procedure, and will assign a penalty, which will be reflected in the number
of points assigned to the particular skill.
Note—See also FAP03 assessment sheet on the following page.
CLINICAL PROFICIENCY EXAMINATION Food Animal Practice
Standard MOA 2012
For use ONLY during calendar year 2012 52
FAP03 ASSESSMENT (clinical procedures station)
PAGE ONE
Activity/Skill
MAX
POINTS
CANDIDATE
SCORE
PART A
Candidate is scored on ability to correctly and efficiently:
50
i. Prepare the udder for routine milking
ii. Obtain a milk sample from each quarter, perform CMT, interpret results
NOTE: If candidate is unable to acquire a sufficient volume of milk to
perform a CMT, examiner will provide a milk sample and will deduct 6
points.
iii. Obtain milk sample for bacterial culture, interpret results, and provide a
therapeutic plan for the dairyman consistent with the culture results
provided
iv. Correctly place a halter and restrain animal
PART B
Candidate is scored on ability to correctly and efficiently perform 5 of the
following 15 skills:
NOTE: Candidates will perform two (2) skills randomly selected from skills
i-iv, worth 13 points each, and three (3) skills randomly selected from skills
v–xv, worth 8 points each.
50
i. Place a mouth gag and perform an examination of the oral cavity
ii. Pass a stomach tube, ensure it is placed correctly, collect rumen fluid
iii. Select the appropriate vacutainer, collect a blood sample by coccygeal
venipuncture
iv. Manually collect urine sample, describe sample, perform a gross
assessment and dipstick test, interpret results (including limitations of
dipstick).
Note: Points not deducted if use of correct procedure does not yield a urine
sample; examiner to supply urine sample in this case.
v. Perform abomasal/rumen gas cap identification test, discuss how to
differentiate between rumen gas cap, LDA ping, and pneumoperitoneum,
pneumorectum, or pneumocolon
vi. Demonstrate how to insert an intravenous catheter into the jugular vein
vii. Demonstrate how to perform a caudal epidural injection for the
purposes of analgesia during obstetrical manipulations
viii. Describe how to examine a hind foot for suspected foot lameness
ix. Perform a speculum examination to evaluate cervix
x. Identify where and explain how to inject one of the following drugs:
oxytetracycline, florfenicol, or ceftiofur
xi. Demonstrate a common and easy method to restrain animal to allow
examination of or administration of treatment to the hindquarters
xii. Perform a withers pinch test (ie, grunt test)
xiii. Identify site for, and describe how to perform, cornual nerve block
xiv. Demonstrate paravertebral anesthesia.
xv. Administer oral medication
TOTAL POINTS 100
CLINICAL PROFICIENCY EXAMINATION Food Animal Practice
Standard MOA 2012
For use ONLY during calendar year 2012 53
D. Requirements of the Candidate
Station 4–Bovine theriogenology and public health, food safety, and regulatory issues
Part A: Given a sexually mature cow of mild temperament, sedated if necessary, restrained
appropriately, the candidate will perform a rectal examination, determine if the cow is
pregnant, explain on what basis that determination was made, and discuss the response of that
reproductive tract to a therapeutic dose of prostaglandin. The actual rectal examination must be
completed within 5 minutes. The examiner will stop the rectal examination at 5 minutes if the
candidate has not completed the examination.
See also FAP04 assessment sheet on the following page.
Part B: Given a clinical case scenario appropriate to a bovine fetus placed in an obstetric box (an
obstetric box is a "box" constructed in such a way as to simulate the bovine uterus and prevent
the candidate from visualizing the fetus) in an abnormal presentation, position, or posture (ie: an
abnormality commonly found in veterinary practice), the candidate will ask the examiner/client
questions to solicit any necessary additional history and physical finding (eg, straining, etc),
describe how to prepare the cow for obstetrical examination, describe the malpresentation, -
position, or –posture, using standard terminology, perform the necessary manipulation on the
fetus in the obstetric box in order to facilitate vaginal delivery, place chains on the fetus in the
obstetric box to facilitate delivery, discuss how to determine whether vaginal delivery is possible
in a calf with dystocia, and describe possible alternatives to vaginal delivery.
See also FAP04 assessment sheet on the following page.
Part C: Using the FAP05 assessment sheet, the candidate will list five (5) of the drugs currently
(ie, 1 week prior to examination date) prohibited for extralabel use in food animals in the United
States or Canada (answer for the country in which examination is taking place; if examination is
taking place in Scotland, answer for the United States).
Note–See also example FAP05 assessment sheet on the following pages.
Note—Candidate must list 5 of the currently prohibited drugs (ie, 1 week prior to examination
date) to receive credit. If candidate does not list 5 prohibited drugs, or lists non-prohibited
drugs, points will be subtracted. Part C will comprise 5% of the total score for the Food Animal
Practice section of the CPE.
CLINICAL PROFICIENCY EXAMINATION Food Animal Practice
Standard MOA 2012
For use ONLY during calendar year 2012 54
FAP04 ASSESSMENT (bovine theriogenology)
PAGE 1
Activity/Skill
MAX
POINTS
CANDIDATE
SCORE
PART A
Points will be deducted if candidate does not complete the actual rectal
examination within 5 minutes or the entire Part A within 10 minutes.
Maximum points awarded if either is not completed within time limit: 60% of
total points allowed for part A (ie, 24 pts)
Candidate is scored on the following competencies:
40
a. Perform rectal examination and determine pregnancy status
b. Explain on what basis pregnancy determination was made
c. On the basis of the rectal examination, describe the response to
prostaglandin administration, including the basis on which that
determination was made (eg, ovarian structures), and discuss sequela
to prostaglandin administration.
Note: Points will be deducted for describing response to prostaglandin for
anything other than the correct rectal palpation findings. Maximum points
awarded for correctly describing response to prostaglandin for incorrect rectal
exam findings is 60% of total points allowed for this skill.
PART B
Candidate is scored on ability to: 60
a. Elicit any additional necessary information from the client (examiner)
b. Describe how to perform an obstetrical examination, including
preparation of animal and self
c. Identify malpresentation, -posture, -position
d. Correct malpresentation, -posture, -position
e. Place chains/ropes
f. Discuss alternative delivery plans
g. Communicate to client/examiner post-delivery cow and calf care
TOTAL POINTS 100
CLINICAL PROFICIENCY EXAMINATION Food Animal Practice
Standard MOA 2012
For use ONLY during calendar year 2012 55
FAP05 ASSESSMENT (public health, food safety, and regulatory issues)
PAGE ONE
ACTIVITY/SKILL
MAX
POINTS
CANDIDATE
SCORE
PART C
Candidate must list 5 of the currently prohibited drugs (ie, 1-week prior to
examination date) to receive full credit. If candidate does not list 5 of the
currently prohibited drugs, full points will not be awarded, or if candidate
lists non-prohibited drugs, points will be subtracted. Part C is worth 5% of
the total score for the Food Animal Practice section of the CPE.
Candidate is scored on ability to correctly:
100
List 5 drugs prohibited for extralabel use in food animals in the United
States (for candidates tested in the US or Scotland) or Canada (for
candidates tested in Canada):
TOTAL POINTS 100
CLINICAL PROFICIENCY EXAMINATION Food Animal Practice
Standard MOA 2012
For use ONLY during calendar year 2012 56
E. Food Animal Practice Summary and Final Score Sheet
FAP06 ASSESSMENT (Food Animal Practice Section Summary)
STATION (area)
Raw Points
Awarded
Weighting Weighted
Points
Awarded
STATION 1; Clinical Case, Bovine
Total points from FAP01 Assessment
30%
STATION 2; Clinical Case, Other Food Animal
Total points from FAP02 Assessment
30%
STATION 3; Clinical Procedures
Total points from FAP03 Assessment
20%
STATION 4; Bovine Theriogenology
Total points from FAP04Assessment
15%
STATION 4; Public Health, Food Safety, and Regulatory
Total points from FAP05 Assessment
5%
FINAL SCORE (60 weighted points required to pass)
100%
CLINICAL PROFICIENCY EXAMINATION Food Animal Practice
Standard MOA 2012
For use ONLY during calendar year 2012 57
THIS PAGE INTENTIONALLY LEFT BLANK
Manual of Administration Necropsy
Standard MOA 2012
For use ONLY during calendar year 2012 58
NECROPSY
A. Competencies
The Necropsy section is a single-station section that will assess the candidate's ability to:
perform a necropsy and take tissue samples for histopathology
B. Time Limit
Maximum time, 90 minutes
C. Set-up Information
1. Animal Requirements—Animal carcass (1 per candidate, carcass to be 45 kg or less in weight
and selected from porcine, canine, feline, bovine, equine, caprine, or ovine animals).
2. People Requirements—1 veterinary examiner/3 candidates and 1 technical assistant/5 candidates
Section Coordinator or equivalent—This person organizes and sets up the specific section of the
examination and is responsible for the overall quality control and administration of that section (see CPE
Manual of Administration). Section Coordinators must have a DVM degree (or equivalent) and been
practicing in the section/discipline within the last 10 years, with a minimum of five (5) years experience
in the section/discipline.
Examiner—This person coordinates and sets up the station with the Section Coordinator, administers the
station, and is directly responsible for evaluating the candidates. The examiner also signs off as the
primary examiner on all assessment sheets, even when a secondary examiner or technician takes part
in assessing a candidate’s performance. Examiners must have a DVM degree (or equivalent) and been
practicing in the section/discipline within the last 10 years, with a minimum of two (2) years clinical
experience in the section/discipline. In addition, beginning in 2011, every examiner must participate in
an ECFVG (and/or NEB)-approved CPE examiners’ training session at least one time every four years.
Technical Assistant—This person assists the examiner(s) in monitoring the examination and may assist
in evaluating the candidates. He/She must possess training and expertise in the species/procedure for
which he/she is assisting. If the technical assistant is responsible for assisting the examiner(s) in
candidate evaluation, he/she must be under the direct supervision of the examiner and have licensing,
certification, or other documentation of expertise in that section/discipline.
3. Facilities and Equipment
a. 1 room/area suitable for conducting necropsies.
b. Timing device visible from each station to track elapsed examination time.
The facilities must assure the safety of personnel and candidates and provide for the safety and welfare
of the animals. The facilities and equipment must be adequate to examine multiple candidates
simultaneously.
The facilities and equipment must comply with all relevant local, state, provincial, and United States or
Canadian federal regulations. These requirements include, but are not limited to: zoning, radiation
safety, personnel and animal safety, animal care and use, and potentially toxic or dangerous substances
(anesthetic gases).
Manual of Administration Necropsy
Standard MOA 2012
For use ONLY during calendar year 2012 59
Because candidates are being evaluated on their ability to practice veterinary medicine at the entry level
of competence, physical facilities and equipment must simulate those used in a contemporary US or
Canadian veterinary clinical facility.
Candidates for the examination must be provided with an adequate staging area for orientation, storage,
and rest.
4. Supplies/Information Provided By The Examiner
a. Facilities and instruments to perform a necropsy similar to what would be present in
veterinary practice (eg, knives, scissors, bone cutters, etc).
b. Supplies required for sample taking to include marking pens and labels.
c. Coveralls, boots, and gloves.
d. Safety equipment (gloves, aprons, goggles, etc).
5. Supplies Provided By The Candidate
a. Clean laboratory coat.
b. Pens/pencils
Manual of Administration Necropsy
Standard MOA 2012
For use ONLY during calendar year 2012 60
D. Requirements of the Candidate
Given an animal carcass (100 pounds [45 kg] or less in weight and selected from porcine, canine,
feline, bovine, equine, caprine or ovine animals) and an appropriate environment for conducting
a necropsy, the candidate will perform a complete necropsy by completing, at a minimum, the
following tasks:
a. Thoroughly examine intact carcass
b. Open carcass, examine major cavities, remove viscera
c. Examine major organs, to include palpating lungs for inflation.
d. Examine muscles, joints (at least one each from a hind and fore limb)
e. Examine endocrine glands, lymph nodes
f. Remove head at atlanto-occipital joint as if to submit for rabies examination
The candidate will also take and preserve a tissue section of the appropriate size/ thickness from
each of the following organs for histopathology (all tissues to be collected in one container;
fixative or fixative substitute will be provided; candidate to add appropriate volume of fixative
for amount of tissue collected). Sites will post the master list of specimens to be collected in the
necropsy room:
a. Kidney
b. Liver
c. Spleen
d. Lung
e. Heart
f. Small intestine
g. Colon
h. Skeletal muscle
i. Pancreas
j. Thyroid gland
k. Adrenal gland
l. Internal lymph node
m. Peripheral lymph node
n. Stomach
Note: See also NEC01 assessment sheet on following page.
Manual of Administration Necropsy
Standard MOA 2012
For use ONLY during calendar year 2012 61
E. Necropsy Final Score Sheet
NEC01 ASSESSMENT (necropsy section)
PAGE ONE
ACTIVITY/SKILL
MAX
POINTS
CANDIDATE
SCORE Perform complete necropsy
85
a. Thoroughly examine intact carcass
b. Open carcass, examine major cavities, remove viscera, remove
head
c. Examine major organs, to include palpating lungs for inflation
d. Examine muscles, joints (at least one each from a hind and fore
limb)
e. Examine endocrine glands, lymph nodes
Sample collection for histopathology
15
a. Kidney
b. Liver
c. Spleen
d. Lung
e. Heart
f. Small intestine
g. Colon
h. Skeletal muscle
i. Pancreas
j. Thyroid gland
k. Adrenal gland
l. Internal lymph node
m. Peripheral lymph node
n. Stomach
o. Appropriate volume of fixative for tissue
TOTAL POINTS
100
Please note: A minimum of 60 points is needed to pass the Necropsy section.
Manual of Administration Radiographic Positioning
Standard MOA 2012
For use ONLY during calendar year 2012 62
RADIOGRAPHIC POSITIONING
A. Competencies
The Radiographic Positioning section is a single-station section that will assess the candidate's ability to:
determine anatomical structures and views necessary to radiographically diagnosis a clinical
condition and produce diagnostic quality radiographic images of those structures
B. Time Limit
Maximum time, 45 minutes
C. Set-up Information
1. Animal Requirements—Canine animal of mild temperament (sedated or anesthetized if
necessary).
2. People Requirements—1 veterinary examiner and 1 technical assistant per candidate
Section Coordinator or equivalent—This person organizes and sets up the specific section of the
examination and is responsible for the overall quality control and administration of that section (see CPE
Manual of Administration). Section Coordinators must have a DVM degree (or equivalent) and been
practicing in the section/discipline within the last 10 years, with a minimum of five (5) years experience
in the section/discipline.
Examiner—This person coordinates and sets up the station with the Section Coordinator, administers the
station, and is directly responsible for evaluating the candidates. The examiner also signs off as the
primary examiner on all assessment sheets, even when a secondary examiner or technician takes part
in assessing a candidate’s performance. Examiners must have a DVM degree (or equivalent) and been
practicing in the section/discipline within the last 10 years, with a minimum of two (2) years clinical
experience in the section/discipline. In addition, beginning in 2011, every examiner must participate in
an ECFVG (and/or NEB)-approved CPE examiners’ training session at least one time every four years.
Technical Assistant—This person assists the examiner(s) in monitoring the examination and may assist
in evaluating the candidates. He/She must possess training and expertise in the species/procedure for
which he/she is assisting. If the technical assistant is responsible for assisting the examiner(s) in
candidate evaluation, he/she must be under the direct supervision of the examiner and have licensing,
certification, or other documentation of expertise in that section/discipline.
3. Facilities and Equipment
a. X-ray room/area with conventional or digital radiographic equipment.
b. Timing device visible from each station to track elapsed examination time.
The facilities must assure the safety of personnel and candidates and provide for the safety and welfare
of the animals. The facilities and equipment must be adequate to examine multiple candidates
simultaneously.
The facilities and equipment must comply with all relevant local, state, provincial, and United States or
Canadian federal regulations. These requirements include, but are not limited to: zoning, radiation
safety, personnel and animal safety, animal care and use, and potentially toxic or dangerous substances
(anesthetic gases).
Manual of Administration Radiographic Positioning
Standard MOA 2012
For use ONLY during calendar year 2012 63
Because candidates are being evaluated on their ability to practice veterinary medicine at the entry level
of competence, physical facilities and equipment must simulate those used in a contemporary US or
Canadian veterinary clinical facility.
Candidates for the examination must be provided with an adequate staging area for orientation, storage,
and rest.
4. Supplies/Information Provided By The Examiner
a. Radiographic film and automated film processing equipment (not operated by candidates)
OR digital radiographic equipment.
b. Accessories and supplies for preparing radiographs.
c. Safety equipment (gloves, aprons, goggles, etc).
5. Supplies Provided By The Candidate
a. Clean laboratory coat.
b. Pens/pencils
c. Dosimeter (optional; if the candidate wishes to monitor personal levels of radiation during
the examination, the candidate will provide his/her own dosimeter).
Manual of Administration Radiographic Positioning
Standard MOA 2012
For use ONLY during calendar year 2012 64
D. Requirements of the Candidate
Part A: Given a sedated or anesthetized canine animal, and an x-ray machine (either digital or
conventional), appropriate accessories, and a suspected diagnosis for the animal, the candidate
will, USING NON-HUMAN RESTRAINT ONLY, position the animal in order to produce appropriate
diagnostic quality radiographic images to confirm or rule out the suspected diagnosis. The
image(s) produced must be the appropriate views of the appropriate anatomic structures/region
and be of diagnostic quality.
Part B: Given a digital or conventional x-ray machine (KVP, Ma, time settings) and a
radiographic technique chart specific for that specific machine, the candidate will determine the
required settings for the above exposures, set the machine, employ radiation safety measures and
take the required exposures to obtain appropriate diagnostic quality radiographs. The candidate
will be allowed to evaluate the quality of each initial radiographic image and allowed to repeat
each image only one time, if desired by candidate. In any situation where images are repeated,
the candidate is allowed to designate which images should be scored.
All activities must be completed with the candidate practicing radiation safety. Failure to use
appropriate radiation safety precautions (to include, but not limited to, failure to use non-human restraint
and protective gear) that results in exposing the candidate, the technician, or the examiner to risk is
considered a fatal flaw and the candidate will be dismissed from this station and receive no points for the
station.
Note—A veterinary examiner will assess each candidate’s ability to position an animal and take a
diagnostic quality radiograph.
Note—See also RAD01 assessment sheet on the following page.
Manual of Administration Radiographic Positioning
Standard MOA 2012
For use ONLY during calendar year 2012 65
E. Radiographic Positioning Final Score Sheet
RAD01 Assessment (radiographic positioning)
ACTIVITY/SKILLS
MAX
POINTS
CANDIDATE
SCORE
Part A: Candidate is assessed on his/her ability to position patient, to
include selection of appropriate views and structures or regions.
50
a. Lateral view: to include positioning legs, measuring thickness, setting
focal-film distance, and other tasks necessary to take a diagnostic
radiograph
b. Ventrodorsal (VD)/dorsoventral (DV) view: to include positioning
legs, measuring thickness, setting focal-film distance, and other tasks
necessary to take a diagnostic radiograph
Part B: Images designated by candidate are assessed for the following
qualities:
50
a. Lateral view: to include visualization of all anatomical borders,
absence of rotation, and use of markers, proper contrast and density,
and collimation
b. Ventrodorsal (VD)/dorsoventral (DV) view: to include visualization of
all anatomical borders, absence of rotation, and use of markers, proper
contrast and density, and collimation
Radiation safety Used Did not use
Failure to use appropriate radiation safety exposing the candidate, the
technician, or the examiner to risk is considered a fatal flaw and the
candidate should be dismissed from this station and a zero score be
recorded for the station. If radiation safety precautions are observed,
it should be so noted here, but no additional points will be provided.
This includes but is not limited to failure of the candidate to use non-
human restraint and failure to use protective gear.
TOTAL POINTS 100
Please note: a minimum of 60 points is needed to pass the Radiographic Positioning section.
CLINICAL PROFICIENCY EXAMINATION Small Animal Medicine
Standard MOA 2012
For use ONLY during calendar year 2012 66
SMALL ANIMAL MEDICINE
A. Competencies
The small animal medicine section will assess the candidate's ability to:
evaluate a clinical small animal medicine case (Station 1: Clinical Evaluation)
write medical management plans, including a necessary prescription, for a hospitalized patient
(Station 2: Medical Management)
B. Time
Maximum time, 1.5 hours (90 minutes), with time allotments per station as follows:
45 minutes maximum for Station 1 (Clinical Evaluation)
45 minutes maximum for Station 2 (Medical Management)
C. Set-up Information
1. Animal Requirements
a. Canine or feline animal affected by a common clinical condition (Station 1).
b. Live animals will not be used at Station 2 (Medical Management). Rather, a written record of
the current status of a dog or cat hospitalized with a common clinical condition will be
provided, with the candidate assessed on his/her ability to write an appropriate medical
management plan for a specified time period.
All animal weights will be provided in kilograms [kg].
In order to provide variation in clinical case presentations at each clinical station, a minimum of two (2)
clinical cases must be furnished (one shall be used for the morning group of candidates and another for
the afternoon group of candidates). Clinical cases used in a CPE site examination may not be used at
that site for three subsequent examinations.
2. People Requirements
a. One veterinary examiner per candidate at Station 1
b. One veterinary examiner at Station 2
Section Coordinator or equivalent—This person organizes and sets up the specific section of the
examination and is responsible for the overall quality control and administration of that section (see CPE
Manual of Administration). Section Coordinators must have a DVM degree (or equivalent) and been
practicing in the section/discipline within the last 10 years, with a minimum of five (5) years experience
in the section/discipline.
Examiner—This person coordinates and sets up the station with the Section Coordinator, administers the
station, and is directly responsible for evaluating the candidates. The examiner also signs off as the
primary examiner on all assessment sheets, even when a secondary examiner or technician takes part
in assessing a candidate’s performance. Examiners must have a DVM degree (or equivalent) and been
practicing in the section/discipline within the last 10 years, with a minimum of two (2) years clinical
experience in the section/discipline. In addition, beginning in 2011, every examiner must participate in
an ECFVG (and/or NEB)-approved CPE examiners’ training session at least one time every four years.
Technical Assistant—This person assists the examiner(s) in monitoring the examination and may assist
in evaluating the candidates. He/She must possess training and expertise in the species/procedure for
CLINICAL PROFICIENCY EXAMINATION Small Animal Medicine
Standard MOA 2012
For use ONLY during calendar year 2012 67
which he/she is assisting. If the technical assistant is responsible for assisting the examiner(s) in
candidate evaluation, he/she must be under the direct supervision of the examiner and have licensing,
certification, or other documentation of expertise in that section/discipline.
3. Facilities and Equipment
a. 1 small animal examining room for Station 1.
b. 1 room/area for Station 2 with appropriate space to allow for reading and writing of medical
records.
c. Timing device visible from each station to track elapsed examination time.
The facilities must assure the safety of personnel and candidates, and provide for the safety and
welfare of the animals.
The facilities and equipment must be adequate to examine multiple candidates simultaneously.
The facilities and equipment must comply with all relevant local, state, provincial and United States or
Canadian Federal regulations. These requirements include, but are not limited to zoning, radiation
safety, personnel and animal safety, animal care and use, and potentially toxic or dangerous substances
(anesthetic gases).
Because candidates are being evaluated on their ability to practice veterinary medicine at the entry level
of competence, physical facilities and equipment must simulate those used in a United States or
Canadian contemporary veterinary clinical facility.
Candidates for the examination must be provided with an adequate staging area for orientation, storage,
and rest.
4. Supplies/Information Provided By The Examiner
a. Instruments/supplies appropriate for the case and commonly found in examination rooms in a
typical US or Canadian veterinary practice (eg, microscope, view box or computer for digital
radiographs, otoscope, ophthalmoscope, thermometer).
b. Test data relevant to the clinical case or hospitalized patient as per the request of the
candidate.
5. Supplies Provided By The Candidate
a. Stethoscope, penlight, clean laboratory coat
b. Wrist watch with second hand
CLINICAL PROFICIENCY EXAMINATION Small Animal Medicine
Standard MOA 2012
For use ONLY during calendar year 2012 68
D. Requirements of the Candidate
Note- If a candidate compromises his/her personal safety or the safety of personnel while working
around animals during the Small Animal Medicine section of the CPE, the examiner will intervene, may
terminate the procedure, and will assign a penalty that will be reflected in the number of points assigned
to the particular skill. The entire Small Animal Medicine section may also be scored as
UNSATISFACTORY depending on the nature of the safety violation(s).
The examiner will assist an animal and terminate the Small Animal Medicine section of the CPE if a
candidate by an act of omission or commission puts an animal into an inhumane or life threatening
situation and the situation is not corrected by the candidate. The entire Small Animal Medicine section
will be scored as UNSATISFACTORY regardless of the score accumulated at the point of termination.
Station 1–Clinical Evaluation
Given an examiner acting as the client with a dog or cat affected with a condition commonly
found in veterinary practice, the candidate will question the client/examiner in order to
determine the history of the patient, perform a systematic physical examination, record the
results of the history and physical examination on the provided form (see Appendix One—Small
Animal Medicine); develop an initial problem list, differential diagnoses, and diagnostic plan,
request appropriate and reasonable initial diagnostic tests, interpret test data, refine the
problem list and differential diagnoses until a most likely diagnosis can be reached, develop a
prognosis and therapeutic plan specific for the case, and orally communicate the information to
the client/examiner. The candidate will record the results from the history and physical
examination on the form provided in Appendix 1 of the Small Animal Medicine Section of the
CPE MOA.
When required and requested by the candidate, standard laboratory data for appropriate
diagnostic tests will be provided in written form with normal values.
Note—See also the SAM01 assessment sheet on the following pages
CLINICAL PROFICIENCY EXAMINATION Small Animal Medicine
Standard MOA 2012
For use ONLY during calendar year 2012 69
SAM01 ASSESSMENT (clinical evaluation station)
PAGE 1
ACTIVITY/SKILL MAX
POINTS
CANDIDATE
SCORE
History taking
Note: Candidates will be assessed on their ability to accurately, effectively
and efficiently communicate with the client/examiner to appropriately elicit a
complete history from client/examiner, which may include the following:
15
a. Signalment, including breed
b. Presenting complaint
c. Duration of presenting complaint
d. Previous treatment(s); response to those treatments
e. Past problems
f. Extent of involvement of other animals on premises
g. Vaccination history
h. Nutrition history
i. Husbandry
j. Accurately recording all findings on the appropriate medical form
Physical examination
Attention to personal/professional hygiene will be evaluated (eg, use of clean
instruments, washing hands when appropriate, discarding used
equipment/supplies appropriately)
Can involve the following competencies:
15
a. Performing distance examination, including body condition
b. Performing thorough and systematic hands-on examination
appropriate for the presenting complaint
c. Accurately assessing the patient (eg, determining correct heart and
respiratory rate, temperature, respiratory pattern, etc). Candidate
may lose points for recording a finding that is not actually present
d. Handling the patient humanely
e. Accurately recording all findings on the appropriate medical form
Developing initial problem list, differential diagnoses, and diagnostic
plan
Note: candidates may lose points for requesting inappropriate or
unnecessary and invasive diagnostic tests. Candidates will, therefore, need
to take in account risks inherent in all tests, Diagnostic plans developed must
be appropriate for the case.
Can involve the following competencies:
20
a. Identifying all problems
b. Developing primary differential diagnoses list for most relevant
problems identified
c. Developing initial diagnostic plan, to include ordering relevant
tests and reviewing test results A candidate may lose points
(maximum possible point loss is 7.5), which may result in a negative
score for this competency, if he/she orders tests that are not needed.
SAM01 continued on next page
CLINICAL PROFICIENCY EXAMINATION Small Animal Medicine
Standard MOA 2012
For use ONLY during calendar year 2012 70
SAM01 ASSESSMENT (clinical evaluation station)
PAGE 2
ACTIVITY/SKILL
MAX
POINTS
CANDIDATE
SCORE
Refining initial problem and differential diagnoses list on the basis of
interpretation of test results, to include arriving at a most likely
diagnosis
May involve the following competencies:
20
a. Interpreting initial laboratory test results
b. Ruling out diagnoses on the initial list
c. Ruling in diagnoses on the initial list
d. Requesting additional diagnostic tests as necessary. A candidate
may lose points (maximum possible point loss is 2), which may result
in a negative score for this competency, if he/she orders tests that
are not needed.
e. Interpreting additional laboratory test results if requested
f. Arriving at the most likely diagnosis
Developing therapeutic plan
Note: points will be deducted for developing a correct therapeutic plan for a
set of differentials that does not include the correct diagnosis.
Can involve the following competencies:
15
a. Developing therapeutic plan specific for the patient, to include
addressing treatment, prevention and control issues, and
appropriate follow-up
b. Developing the appropriate prognosis
Communicating effectively with client/examiner
Can involve the following competencies:
15
a. Effectively communicating initial problem list and differentials to
client/examiner
b. Effectively communicating initial findings and diagnostic plan to
client/examiner
c. Effectively communicating need for any secondary diagnostic test(s)
to client/examiner
d. Effectively communicating most likely diagnosis and prognosis to
client/examiner
e. Effectively communicating therapeutic plan to client/examiner
f. Effectively answering client/examiner’s questions
g. Avoidance of medical jargon in communications with
client/examiner
TOTAL 100
CLINICAL PROFICIENCY EXAMINATION Small Animal Medicine
Standard MOA 2012
For use ONLY during calendar year 2012 71
D. Requirements of the Candidate
Station 2–Medical Management
Given a clinical case scenario (eg, signalment, history, initial physical examination findings, and
initial diagnostic test results) for a hospitalized canine or feline patient, the candidate will use the
Medical Management and Treatment Order Form and the Prescription Form (see Appendix 3 &
Appendix 2 of this section of the MOA) to develop and write an assessment of the patient, using
a problem-oriented approach (eg, SOAP); write a prescription appropriate for management of
the case; and write orders (eg, treatment orders, monitoring parameters, additional diagnostic
tests, contingency plans) for a technician who will be monitoring the patient for the next 12 hour
time period. Once the written medical record, treatment orders, and prescription are complete,
the candidate will also be required to orally communicate his/her assessment and written orders
to the examiner, who will be acting as the technician taking over the animal’s care in accordance
with the candidate’s instructions.
When required and requested by the candidate, standard laboratory data for appropriate
diagnostic tests will be provided in written form with normal values.
Written records/orders may include any or all of the following:
an assessment of the findings listed on the medical management and treatment order
form;
an initial differential diagnoses list;
a tentative/initial diagnosis;
additional diagnostic tests required;
a treatment plan to include any drug dosages or fluid rates;
physiological parameters to be monitored by the technician and how often;
actions to be taken by the technician if parameters fall outside an acceptable range or
animal behaves in a specified abnormal manner;
initial prognosis; and
other relevant case information or treatment orders.
Candidates will not be scored on writing quality or spelling per se, but written records/ treatment
orders must be legible, coherent, and recorded in a logical and systematic manner.
Note—See also the example SAM02 assessment sheet on the next page.
CLINICAL PROFICIENCY EXAMINATION Small Animal Medicine
Standard MOA 2012
For use ONLY during calendar year 2012 72
SAM02 ASSESSMENT (medical management)
PAGE 1
ACTIVITY/SKILL
MAX
POINTS
CANDIDATE
SCORE
Written record
Candidates will be assessed on their ability to accurately and logically
write a medical record, which may include the following:
60
a. Accurately recording a SOAP
b. Accurately recording orders
c. Accurately and completely writing an appropriate prescription
Oral communication
Can involve the following competencies:
40
a. Succinctly relaying pertinent information in the written record
to the examiner, who is acting as the technician taking over
the animal’s care in accordance with the written assessment
and treatment orders developed by the candidate
b. Concisely answering questions the examiner, who is acting as
the technician taking over the animal’s care, may have
regarding the written assessment or treatment orders
developed by the candidate
TOTAL 100
CLINICAL PROFICIENCY EXAMINATION Small Animal Medicine
Standard MOA 2012
For use ONLY during calendar year 2012 73
E. Small Animal Medicine Summary and Final Score Sheet
SAM03 ASSESSMENT (Small Animal Medicine Section Summary) STATION
Raw Points
Awarded
Weighting
Weighted
Points
Awarded STATION 1; Clinical Evaluation
Total points awarded from SAM01 Assessment
60%
STATION 2; Medical Management
Total points awarded from SAM02 Assessment
40%
FINAL SCORE (60 weighted points required to pass)
100%
CLINICAL PROFICIENCY EXAMINATION Small Animal Medicine
Standard MOA 2012 Appendix 1
For use ONLY during calendar year 2012 74
F. Appendices
Appendix 1—History and Physical Examination Form (for use in SAM Station 1)
Candidate Name: CPE Site/Date/Session (AM/PM)
Patient Species:
Date:
Presenting Complaint:
RECORDING GUIDE
1. Presenting Complaint
2. History of present illness
3. Past History
a) medical
b) surgical
c) trauma
d) vaccinations
4. Husbandry
5. Systems Review
a) integumentary
b) ophthalmic
c) otic
d) respiratory
e) cardiovascular
f) gastro-intestinal
g) urinary
h) reproductive
i) musculoskeletal
j) lymphatic
k) nervous
6. Signature
CLINICAL PROFICIENCY EXAMINATION Small Animal Medicine
Standard MOA 2012 Appendix 1
For use ONLY during calendar year 2012 75
Candidate Name: CPE Site/Date/Session (AM/PM)
Patient Species:
Date:
Presenting Complaint:
CHECK ABNORMAL AND
DESCRIBE BELOW
1. General Appearance
2. Cardiovascular
3. Respiratory
4. Nervous
5. Musculoskeletal
6. Integumentary
7. Urinary
8. Reproductive
9. Gastro-intestinal
10. Lymphatics
11. Ophthalmic
12. Otic
13. Mucous Membranes
14. Oral Cavity
15. Other Temperature Pulse Respiration Weight Temperament
CLINICAL PROFICIENCY EXAMINATION Small Animal Medicine
Standard MOA 2012 Appendix 2
For use ONLY during calendar year 2012 76
Appendix 2—Prescription Form (for use in SAM Station 2)
CPE site: Date:
Client name:
Animal name:
Rx
Nonrefillable Refillable ( times through [date])
DVM name: DEA/Reg Number:
DVM signature:
CLINICAL PROFICIENCY EXAMINATION Small Animal Medicine
Standard MOA 2012 Appendix 3
For use ONLY during calendar year 2012 77
Appendix 3—Medical Management and Treatment Order Form (for use in SAM Station 2)
-Page 1-
CPE SITE/DATE/SESSION (AM/PM):
CANDIDATE Name/ID
PATIENT INFORMATION
SPECIES/BREED: AGE:
NAME: SEX:
WEIGHT: DATE ADMITTED:
OWNER NAME: OWNER PHONE:
OWNER ADDRESS:
ADMISSION HISTORY AND PHYSICAL EXAMINATION FINDINGS
CLINICAL PROFICIENCY EXAMINATION Small Animal Medicine
Standard MOA 2012 Appendix 3
For use ONLY during calendar year 2012 78
THIS PAGE INTENTIONALLY LEFT BLANK
CLINICAL PROFICIENCY EXAMINATION Small Animal Medicine
Standard MOA 2012 Appendix 3
For use ONLY during calendar year 2012 79
Appendix 3— Medical Management and Treatment Order Form
-Page 2-
DATE: CANDIDATE NAME/ ID:
CANDIDATE’S WRITTEN RECORDS (Subjective, Objective, Assessment, Plan) NOTE:
Candidate must also complete orders (final page of this form) and attach a completed prescription form
(Appendix 2) for one appropriate prescribed drug
CLINICAL PROFICIENCY EXAMINATION Small Animal Medicine
Standard MOA 2012 Appendix 3
For use ONLY during calendar year 2012 80
Appendix 3— Medical Management and Treatment Order Form
-Page 3-
DATE: CANDIDATE NAME/ ID:
CANDIDATE’S WRITTEN RECORDS (continued)
CLINICAL PROFICIENCY EXAMINATION Small Animal Medicine
Standard MOA 2012 Appendix 3
For use ONLY during calendar year 2012 81
Appendix 3— Medical Management and Treatment Order Form
-Page 4-
DATE: CANDIDATE NAME/ID:
CANDIDATE’S WRITTEN RECORDS (continued)
CLINICAL PROFICIENCY EXAMINATION Small Animal Medicine
Standard MOA 2012 Appendix 3
For use ONLY during calendar year 2012 82
THIS PAGE INTENTIONALLY LEFT BLANK
CLINICAL PROFICIENCY EXAMINATION Small Animal Medicine
Standard MOA 2012 Appendix 3
For use ONLY during calendar year 2012 83
Appendix 3— Medical Management and Treatment Order Form
PATIENT TREATMENT ORDERS
Client Last Name:
PROBLEM LIST
Pet Name:
1.
Signalment:
2.
Doctor Name:
3.
Date:
4.
MONITORING
5 p
6 p
7 p
8 p
9 p
10 p
11 p
12 a
1 a
2 a
3 a
4 a
5 a
FLUID TYPE
Fluid Rates 1. ________________ mL/hr 2. ________________ mL/hr 3. ________________mL/hr
1.
2.
3.
TREATMENTS/DIAGNOSTICS/ADDITIONAL INSTRUCTIONS
CLINICAL PROFICIENCY EXAMINATION
Standard MOA 2012 Surgery
For use ONLY during calendar year 2012 84
SURGERY
A. Competencies
The surgery portion will assess the candidate's ability to:
prepare the patient,
prepare self,
perform the surgical procedure.
ECFVG candidates may find it helpful to review small animal surgery techniques as described in up-to-
date standard textbooks such as:
Fossum TW, Hedlund CS, Hulse DA, et al. Small Animal Surgery, 3rd
ed. (2007), Mosby Year
Book.
Slatter D. Textbook of Small Animal Surgery, 3rd
ed. (2004), Saunders.
B. Time
Maximum time: 2.5 hours from initiation of patient preparation to completion of surgical procedure
(placement of final skin suture). Candidates not completing the surgical procedure in this time period
will fail the Surgery Section of the CPE.
C. Set-up Information
1. Animal Requirements: Canine animal, (female, one per candidate, not obese, weight appropriate
for breed [6-27 kg in weight], not visibly or palpably pregnant, not visibly in heat (ie, no visible
external evidence of bloody vaginal discharge), healthy based on physical examination.
Extreme care will be made to ensure dogs used in this section are sexually intact. However,
should a candidate discover after opening the abdomen that an ovariohysterectomy had
previously been performed, the candidate will indicate this to the examiner by identifying and
demonstrating the ovarian pedicles and the uterine stump. The examiner will then evaluate the
candidate’s skill in closing the surgical site. No additional time will be added.
Animal weights will be provided in kilograms [kg].
2. Minimum People Requirements
a. One veterinary examiner per 3 candidates
b. One technical assistant per 4 candidates
Section Coordinator or equivalent—This person organizes and sets up the specific section of the
examination and is responsible for the overall quality control and administration of that section (see CPE
Manual of Administration). Section Coordinators must have a DVM degree (or equivalent) and been
practicing in the section/discipline within the last 10 years, with a minimum of five (5) years experience
in the section/discipline.
Examiner—This person coordinates and sets up the station with the Section Coordinator, administers the
station, and is directly responsible for evaluating the candidates. The examiner also signs off as the
primary examiner on all assessment sheets, even when a secondary examiner or technician takes part
in assessing a candidate’s performance. Examiners must have a DVM degree (or equivalent) and been
practicing in the section/discipline within the last 10 years, with a minimum of two (2) years clinical
CLINICAL PROFICIENCY EXAMINATION
Standard MOA 2012 Surgery
For use ONLY during calendar year 2012 85
experience in the section/discipline. In addition, beginning in 2011, every examiner must participate in
an ECFVG (and/or NEB)-approved CPE examiners’ training session at least one time every four years.
Technical Assistant—This person assists the examiner(s) in monitoring the examination and may assist
in evaluating the candidates. He/She must possess training and expertise in the species/procedure for
which he/she is assisting. If the technical assistant is responsible for assisting the examiner(s) in
candidate evaluation, he/she must be under the direct supervision of the examiner and have licensing,
certification, or other documentation of expertise in that section/discipline.
3. Facilities and Equipment
a. Rooms (or areas) equipped for the preparation of animals for surgery
b. Rooms (or areas) equipped to carry out the required surgical procedures
c. Timing device visible from each station to track elapsed examination time.
The facilities must assure the safety of personnel and candidates, and provide for the safety and welfare
of the animals.
The facilities and equipment must be adequate to examine multiple candidates simultaneously.
The facilities and equipment must comply with all relevant local, state, provincial and United States or
Canadian Federal regulations. These requirements include, but are not limited to zoning, radiation
safety, personnel and animal safety, animal care and use, and potentially toxic or dangerous substances
(anesthetic gases).
Because candidates are being evaluated on their ability to practice veterinary medicine at the entry level
of competence, physical facilities and equipment must simulate those used in a United States or
Canadian contemporary veterinary clinical facility.
Candidates for the examination must be provided with an adequate staging area for orientation, storage,
and rest.
4. Supplies/Information Provided By The Examiner
a. Surgical supplies and clothing commonly used for the teaching of undergraduate veterinary
surgery, including an assortment of suture materials, gloves, masks, caps, etc.
b. Sterile surgical gown pack; use of/gowning with to be demonstrated during orientation.
There will be variation in the type of supplies available for surgery. Candidates will need to have some
flexibility in the selection of appropriate material. Candidates may be asked to use either standard gowns
or wrap-around gowns.
5. Supplies Provided By The Candidate
a. Stethoscope, rectal thermometer, penlight, clean laboratory coat, surgical scrubs
CLINICAL PROFICIENCY EXAMINATION
Standard MOA 2012 Surgery
For use ONLY during calendar year 2012 86
D. Requirements of the Candidate
The Surgery and Anesthesia sections of the CPE will be administered at the same time. The anesthesia
candidate will anesthetize, stabilize, and monitor the animal while the surgery candidate performs the
surgical procedure.
The Surgery section of the CPE will be scored on a pass/fail basis. No numerical score will be given. A
“pass” equates with at least a minimally competent performance of surgical skills expected of an entry-
level veterinarian. The examiner will use the surgical skills assessment sheet (SU01) as a checklist to
record comments regarding each candidate’s behaviors. The examiner will note both positive and
negative behaviors, but will not provide the candidate with any feedback except in the case of a fatal
flaw (see Surgery Appendix 1).
To receive a passing score in this section, it is essential that candidates recognize and correct breaks in
asepsis at any point during the preparation or surgical procedure. Identifying and correcting breaks in
asepsis is not a fatal flaw, but failing to do so is. This presumes that the break in asepsis is recognized
and corrected before it results in a potentially life-threatening situation for the patient. Each candidate
will be allowed a single exception to this rule—if the examiner, technician, or another CPE team
member recognizes a break in asepsis but the candidate does not, the CPE team member will alert the
candidate so that the candidate can correct the break. Again, this presumes that the CPE team member
recognizes the break before it has resulted in a potentially life-threatening situation for the patient. The
CPE team can only identify one break in asepsis during the entire procedure—from animal and surgeon
preparation to the placement of the final suture. Any other break in asepsis must be recognized by the
candidate. If a candidate fails to do so and/or fails to correct the error, the examiner will intervene and
the candidate will be excused from, and receive a failing grade for, the Surgery Section.
Should a candidate receive an “inadequate behavior/low risk to patient” assessment (column on the
SU01 assessment sheet marked with a +) for three or more skills, he/she will be allowed to complete the
Surgery section (unless the cumulative errors puts the animal’s life in danger) but will receive a failing
grade for this section.
Should a candidate receive an “inadequate/high risk to patient or did not perform at all” assessment
(column on the SU01 assessment sheet marked with an *) for any one skill, the examiner may interrupt
the examination, correct the error to ensure safety of the animal and personnel, excuse the candidate
from this section, and award the candidate a failing grade for this section. The candidate may not be
allowed to complete the Surgery section of the CPE.
Please note that there are many factors that go into the pass/fail decision in this section. Successful
entry-level performance of the skills assessed in the Surgery Section involves much more than having
the patient survive the surgery—in other words, more than getting through the procedure without being
dismissed for committing a fatal flaw. Candidates are also reminded that the ECFVG is evaluating
clinical procedures on a living animal that may result in deleterious, even fatal consequences to that
animal. Therefore, the assessment of the adequacy of the surgical procedure can be affected by the
discovery of clinical changes that can be ultimately traced to errors made by the candidate surgeon
leading to awarding of a fatal flaw after the surgical procedure has been completed.
CLINICAL PROFICIENCY EXAMINATION
Standard MOA 2012 Surgery
For use ONLY during calendar year 2012 87
1. Surgical skills (SU01)
The candidate will perform an elective ovariohysterectomy, using a ventral midline or ventral
paramedian approach, on a dog that will be maintained in a surgical plane of anesthesia by
another candidate or an anesthetist. A technical assistant will be available to provide materials
but must be instructed by the candidate in all actions to perform. Regardless of source of animals
used in this section, the assumption will be made that surgery is being performed on a client-
owned animal that will be going home after a sufficient recovery period within the veterinary
hospital.
Once the dog is anesthetized, the candidate will prepare the dog for ovariohysterectomy,
prepare him or herself to perform the surgery aseptically; and perform the ovariohysterectomy.
Each candidate will be required to demonstrate the ovarian pedicle and uterine body ligatures to
the examiner prior to release into the abdomen; leave the excised reproductive tract on the
instrument tray so that the examiner can assess the tract as time permits; and announce to the
examiner when he/she is ready to start the abdominal wall closure. When making this final
announcement to the examiner, each candidate must also state the size and type of suture
material he/she will use during the closure, and the examiner will write this on the assessment
sheet. Each candidate must also announce to the examiner when he/she has completed the
abdominal wall closure and must wait for the examiner to check the closure.
See also SU01 on the following pages
CLINICAL PROFICIENCY EXAMINATION Surgery
Standard MOA 2012
For use ONLY during calendar year 2012 88
E. Surgery Final Score Sheet
SU01 Assessment (surgical skills)
PAGE ONE
Patient Preparation—Candidate assessed on
following skills:
Adequate/
Pass
†Inadequate
with low risk
to patient
*Inadequate
with high risk to
patient OR did
not perform task
at all (fatal flaw)
HAIR REMOVAL
Width: at least to mammary chains/teats;
Length: from pubis at least to midway between
xiphoid and umbilicus.
SKIN PREPARATION
Appropriate antiseptic solution(s) used; skin is clean
at the end of preparation; aseptic area is protected
during transfer from prep area to surgery suite or a
second scrub is completed in the surgery suite.
PATIENT POSITIONING
Dog in dorsal recumbency and secured to table.
DRAPING
Application of quadrant drapes and laparotomy sheet
to isolate the surgical field from the haired area.
Examiner Comments on Patient Preparation:
SU01 continued on next page
CLINICAL PROFICIENCY EXAMINATION Surgery
Standard MOA 2012
For use ONLY during calendar year 2012 89
SU01 Assessment (surgical skills)
PAGE TWO
Surgeon Preparation—Candidate assessed on
following skills:
Adequate /
Pass
†Inadequate
with low risk
to patient
*Inadequate
with high risk to
patient
OR did not
perform task at
all (fatal flaw)
SCRUBBING
Must use appropriate antiseptic solution for the
appropriate amount of time; must scrub hands and
forearms appropriately.
GOWNING/GLOVING
Must aseptically don sterile gown and gloves and/or
recognize problems and regown/glove.
Examiner Comments on Surgeon Preparation:
SU01 continued on next page
CLINICAL PROFICIENCY EXAMINATION Surgery
Standard MOA 2012
For use ONLY during calendar year 2012 90
SU01 Assessment (surgical skills)
PAGE THREE
Ovariohysterectomy—Candidate assessed on
following skills:
Adequate /
Pass
†Inadequate
with low risk
to patient
*Inadequate
with high risk to
patient OR did
not perform task
at all
SURGICAL INCISION
Abdominal incision is made ventral midline or
paramedian, but not lateral to the rectus abdominus
muscle.
REMOVAL OF REPRODUCTIVE TRACT
Completely removes both ovaries.
Removes majority of uterus
CLOSURE
Creates secure abdominal wall closure, using
appropriate suture material/size, with apposition of
appropriate layers.
Creates secure subcutaneous and skin closure.
TISSUE HANDLING
Atraumatically handles tissue throughout the
procedure.
HEMOSTASIS
Prevents and/or controls hemorrhage.
KNOT TYING AND LIGATURES
Creates secure ligatures and knots.
PREVIOUSLY SPAYED ANIMAL
Identifies previously spayed animal, if applicable
(mark as NA if not applicable).
Demonstrates pedicles in a previously spayed animal,
if applicable (mark as NA if not applicable).
SU01 continued on next page
CLINICAL PROFICIENCY EXAMINATION Surgery
Standard MOA 2012
For use ONLY during calendar year 2012 91
SU01 Assessment (surgical skills)
PAGE FOUR
Ovariohysterectomy—Candidate assessed on
following skills (continued):
Adequate /
Pass
†Inadequate
with low risk
to patient
*Inadequate
with high risk to
patient OR did
not perform task
at all
ASEPSIS
Maintains aseptic surgical technique throughout the
procedure and/or recognizes and corrects any break
in aseptic technique throughout the surgical
procedure.
Examiner Comments on ovariohysterectomy:
FINAL SURGERY SECTION SCORE (PASS OR FAIL)
Note: candidate’s inability to complete the surgical procedure in the maximum time allotted (2.5
hours) will result in a fail for this section of the CPE
Further Examiner Comments on Final Surgery Section Score (use reverse side of assessment sheet if more
space is required):
Primary examiner’s name/signature:
Secondary examiner’s (or observer’s) name/signature (required only if fatal flaw observed):
CLINICAL PROFICIENCY EXAMINATION Surgery
Standard MOA 2012
For use ONLY during calendar year 2012 92
F. Appendices
Appendix 1—Fatal Flaws
These are failing behaviors that potentially put the animal’s life at risk or personnel in danger. All are
behaviors that may require examiner intervention and will result in a failing grade for the candidate and
potential dismissal from this section of the CPE.
The examiner may stop the Surgery section immediately if any one behavior from the following fatal
flaw list is observed (ie, recognized by the examiner and confirmed by another examiner or observer):
1. Candidate fails to control significant hemorrhage.
2. Candidate fails to create a secure closure of the abdominal wall.
3. Candidate is unable to achieve and maintain an aseptic field (to include patient and
surgeon preparation).
4. Candidate causes significant damage to other tissues/organs (eg, clamping or tying off
one or both ureters).
5. Candidate exhibits any other behavior that would put the animal’s life at risk. The
examiner must document the behavior (eg, leaving instrument/sponge/other surgical
equipment in animal).