Clinical Proficiency Examination (CPE) Standard Manual of Administration

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

For use ONLY during calendar year 2012 i

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



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



Station 1–Clinical Case, Bovine ......................................................................................................................45


Standard MOA 2012

For use ONLY during calendar year 2012 iii

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



E. Necropsy Final Score Sheet .............................................................................................................................61

RADIOGRAPHIC POSITIONING ..........................................................................................................................62

A. Competencies ...................................................................................................................................................62

B. Time Limit ........................................................................................................................................................62



E. Radiographic Positioning Final Score Sheet ..................................................................................................65

SMALL ANIMAL MEDICINE ...............................................................................................................................66

A. Competencies ...................................................................................................................................................66

B. Time .................................................................................................................................................................66



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



E. Surgery Final Score Sheet ...............................................................................................................................88

F. Appendices .......................................................................................................................................................92

Appendix 1—Fatal Flaws ................................................................................................................................92


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 [email protected] 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 ([email protected];

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 [email protected]. 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




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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.


Standard MOA 2012


11

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


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


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.


Standard MOA 2012


12

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.


Standard MOA 2012


13

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).


Standard MOA 2012


14

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; [email protected];

www.avma.org/education/ecfvg/default.asp) and NEB candidates, the NEB office (613-236-1162, ext

116; [email protected]; canadianveterinarians.net/about-programs-structure-examining.aspx).



CLINICAL PROFICIENCY EXAMINATION Anesthesia

Standard MOA 2012

For use ONLY during calendar year 2012 15

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


Standard MOA 2012


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


Standard MOA 2012


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)


Standard MOA 2012


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.


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


Standard MOA 2012


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-


Standard MOA 2012


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


Standard MOA 2012


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


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


THIS PAGE INTENTIONALLY LEFT BLANK

Manual of Administration Anesthesia

Standard MOA 2012 Appendix 1


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.




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




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:




ANESTHESIA RECORD (Page 2)



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.




ANESTHESIA RECORD (Page 3+ )






ANESTHESIA RECORD (Page 4)



(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


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)



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.


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.







Standard MOA 2012














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)


The facilities must assure the safety of personnel and candidates, and provide for the safety and welfare

of the animals.





(anesthetic gases).



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


Standard MOA 2012


h. Hoof pick, left- and right-handed hoof knives, assorted hoof testers


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


Standard MOA 2012




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


Standard MOA 2012


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)


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


Standard MOA 2012


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


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


Standard MOA 2012



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


Standard MOA 2012


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


Standard MOA 2012



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


Standard MOA 2012


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


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


Standard MOA 2012


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


Standard MOA 2012


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


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



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.


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).


Standard MOA 2012















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)



of the animals.





(anesthetic gases).





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


Standard MOA 2012



a. Stethoscope, digital thermometer, and penlight

b. Coveralls and disinfectable footwear


Standard MOA 2012




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.


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.


Standard MOA 2012


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





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


Attention to personal/professional hygiene will be evaluated (eg, use of clean

instruments, washing hands when appropriate, discarding used

equipment/supplies appropriately)


30


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


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).


25

a. Ordering appropriate diagnostic tests and/or necropsy

b. Interpreting laboratory and/or necropsy results

FAP01 continued on next page


Standard MOA 2012


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).


10

a. Developing/communicating therapeutic plan for individual animal

b. Developing/communicating therapeutic plan for herd

c. Developing/communicating prognosis


e. Discussing regulatory issues, public health issues, and food

safety/slaughter for food issues

TOTAL POINTS

100


Standard MOA 2012



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.



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.


Standard MOA 2012


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





e. Past problems


g. Reproductive phase of affected animal

h. Production phase of affected animal

i. Vaccination history

j. Nutrition history

k. Intended use of affected animal


Attention to personal/professional hygiene will be evaluated (eg, use of

clean instruments, washing hands when appropriate, discarding used



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


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.


25

a. Ordering appropriate diagnostic tests and/or necropsy

b. Interpreting laboratory and/or necropsy results

FAP02 continued on next page


Standard MOA 2012


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).


10

a. Developing/communicating therapeutic plan for individual animal

b. Developing/communicating therapeutic plan for herd

c. Developing/communicating prognosis


e. Discussing regulatory issues, public health issues, and food

safety/slaughter for food issues

TOTAL POINTS

100


Standard MOA 2012



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.


Standard MOA 2012


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


Standard MOA 2012



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.


Standard MOA 2012


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


Standard MOA 2012


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


Standard MOA 2012


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


30%

STATION 3; Clinical Procedures


20%

STATION 4; Bovine Theriogenology

Total points from FAP04Assessment

15%

STATION 4; Public Health, Food Safety, and Regulatory


5%

FINAL SCORE (60 weighted points required to pass)

100%


Standard MOA 2012



Manual of Administration Necropsy

Standard MOA 2012


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


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



















a. 1 room/area suitable for conducting necropsies.

b. Timing device visible from each station to track elapsed examination time.


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


(anesthetic gases).


Standard MOA 2012



of competence, physical facilities and equipment must simulate those used in a contemporary US or

Canadian veterinary clinical facility.


and rest.


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).


a. Clean laboratory coat.

b. Pens/pencils


Standard MOA 2012



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.


Standard MOA 2012


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


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


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



















a. X-ray room/area with conventional or digital radiographic equipment.

b. Timing device visible from each station to track elapsed examination time.


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


(anesthetic gases).


Standard MOA 2012



of competence, physical facilities and equipment must simulate those used in a contemporary US or

Canadian veterinary clinical facility.


and rest.


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).


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).


Standard MOA 2012



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.


Standard MOA 2012


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


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)



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.


a. One veterinary examiner per candidate at Station 1

b. One veterinary examiner at Station 2
















Standard MOA 2012






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.





(anesthetic gases).





and rest.


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.


a. Stethoscope, penlight, clean laboratory coat

b. Wrist watch with second hand


Standard MOA 2012



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.



Note—See also the SAM01 assessment sheet on the following pages


Standard MOA 2012


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





e. Past problems


g. Vaccination history

h. Nutrition history

i. Husbandry

j. Accurately recording all findings on the appropriate medical form


Attention to personal/professional hygiene will be evaluated (eg, use of clean

instruments, washing hands when appropriate, discarding used



15


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.


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


Standard MOA 2012


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.


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


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


Standard MOA 2012



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.



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.


Standard MOA 2012


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


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


Standard MOA 2012


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%




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




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




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:




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




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





-Page 3-

DATE: CANDIDATE NAME/ ID:

CANDIDATE’S WRITTEN RECORDS (continued)





-Page 4-

DATE: CANDIDATE NAME/ID:

CANDIDATE’S WRITTEN RECORDS (continued)





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


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


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.


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






















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.


of the animals.





(anesthetic gases).





and rest.


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.


a. Stethoscope, rectal thermometer, penlight, clean laboratory coat, surgical scrubs





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.




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


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


Standard MOA 2012



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:



Standard MOA 2012



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).



Standard MOA 2012



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):


Standard MOA 2012


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).

Clinical Proficiency Examination (CPE) Standard Manual of Administration

Education

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