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Advancing towards a generation of new certification

by
01 September 2016, at 1:00am

Gareth Cross turns his attention to the development of the Advanced Practitioner status and how vets can achieve and maintain it.

ONE OF THE BIG CHANGES SEEN IN THE VETERINARY CLINICAL LANDSCAPE over recent years has been the welcome move by the RCVS to produce a tier of veterinary qualification and expertise between being a GP in a subject and being a Specialist.

Specialist is a protected term by the RCVS in respect to vets and indicates that you are an RCVS-registered Specialist, although this is not something the general public are very aware of. 

The middle tier is the Advanced Veterinary Practitioner and I thought this month I would do a review of the different ways of achieving such a status and maintaining it. Whether the way it is done or has evolved is what everyone thinks is the right way is fodder for another article all together, but please let me know what you think on garethcross@hotmail.com.

To become an advanced veterinary practitioner (AP) you could have applied as a holder of an “old-style” RCVS certificate, and the list of APs is currently mainly populated with those. Other clinical qualifications may also be valid as long as they are at a level 7, so clinical MScs and postgraduate qualifications from other countries may be valid too.

If you look at the current list of advanced veterinary practitioners, most are holders of the old-style certs and a few from BSAVA and Harper Adams are now filtering through (just under 10 of each).

The RCVS withdrew its old-style certificates around 10 years ago and there was a gap in provision for many subjects between those being pulled and a provision being made for them to be valid for AP status. 

A big criticism of the RCVS in both its CertAVP and AP designated list was that initially it released the lists with subjects that had no way of studying for them. For some subjects that gap has only just been closed, and not by the RCVS in some cases. For example, in ophthalmology the BSAVA has its first cohort of students nearing the end of their studies, and Improve/Harper Adams/ ESPVS did immediately release an ophthalmology certificate, but people who took it initially cannot go for AP status, whereas those taking it now can upgrade. A bit of a disaster for that ESPVS cohort.

Minor species such as pig and sh were left by the RCVS without a route to AP status, as was dermatology for a time. As far as I can make out there is still no such thing as an advanced practitioner in small animal veterinary dentistry.

For many vets looking to do further qualifications in the gap between the RCVS certs being withdrawn and new ones coming in it was a frustrating time, especially as for many that gap will still be there, or they will have done a certificate with a provider that now cannot be used for AP status.

However, for the current generation of new and recent graduates I think it is finally getting there and looking forward it all looks very promising with a wide range of subjects and a choice of three providers.

The RCVS provides designated AP status in many specific clinical disciplines in most of the species we deal with as well as a more general Equine/Production Animal/Small Animal practice. This more or less ties in with its own certificate: the CertAVP or certificate in advanced veterinary practice.

There always has been a slight feeling of conflict of interest in the RCVS being both a commercial provider of certi cates and being judge and jury in what letters we can put after our name in terms of who gets to be an “Advanced Veterinary Practitioner”. 

 I know from interviewing other CPD providers over the years that this is a sore point. It was also interesting to read Richard Stephenson’s article (VP, August issue) describing a row in the RCVS education committee some years ago about conflict of interest as people sitting on the committee crafting the AP concept had a conflict of interest with CPD providers they worked for. We are a small, privately-funded profession with an even smaller elite of clinicians, some of whom are also on the committees that control these things.

Broadly speaking, there are three main ways that a vet now looking to be an AP can go: 1. Enrol for an RCVS modular Certificate in Advanced Veterinary Practice. These can be designated to t with an AP designation or be more generalised. Very modular and can be done over 10 years maximum. 2. Improve/ESPVS/Harper Adams provide a range of taught modular courses in clinical subjects and an add-on professional key skills (PKS) module to allow application for AP status. Three to five years, roughly £10,000 all in. 3. BSAVA provides a taught course in clinical subjects (e.g. surgery, medicine, ophthalmology), with additional online learning including the PKS element required for AP status. Three to five years and a similar price to the Improve one.

I asked the providers some specific questions regarding AP status: 

RCVS

Could you provide some general comments on how people maintain their AP status?

For AP status, you have to re-validate every five years and show that you meet the CPD requirement of 250 hours over five years of which at least 125 hours must be in your area of designation. And of course, we expect all vets to meet the RCVS CPD requirement and keep their knowledge up to date.

What qualifications are acceptable for AP status consideration?

We’ve accepted a range of qualifications in addition to the ones you mention and MScs are specifically mentioned in the criteria – I think I signposted you to Section H of the guidance note at the link on the website. Also, I need to stress that ... it is only when the [ESPVS] qualifications have been awarded in partnership with Harper Adams that we accept them.

ESPVS

In 2012, Improve International and ESVPS formed a three-way partnership with Harper Adams University (HAU).

A Postgraduate Certificate (PgC) is a recognised higher education qualification which represents a Master’s Level 7 qualification and provides 60 academic credits, 30 ECTS.

Veterinary surgeons achieving a PgC can apply to the RCVS for Advanced Practitioner status as long as 40 of the 60 academic credits achieved are in the chosen clinical area. To maintain AP status, vets are also required to provide evidence of having undertaken CPD in key areas of professional development or complete a 10-credit module covering veterinary professional skills and development.

BSAVA

The BSAVA PGCerts are each approved as an appropriate Level 7 60-credit postgraduate qualification for the purposes of the AP list. There are currently four PGCerts available – in small animal medicine, small animal surgery, small animal emergency and critical care, and small animal ophthalmology.

Each takes a minimum of three years to complete (two years attending day courses, approximately once monthly, with online learning between courses followed by a formal written exam; one year preparing and submitting case reports) but studies may be undertaken less intensively up to a maximum of five years.

Annual enrolment fee is payable for each of the first three years (in 2016 £3,231 plus VAT). This fee includes all day course registrations, all online resources and activities, all exam fees (including resits if necessary), Nottingham Trent registration fees, BSAVA membership, and a pastoral mentor support network.

If a student extends their studies over four or five years, then the full annual fee is not payable in years four and five. Students only pay a fee allowing us to register them with NTU (currently £100 plus VAT) and their BSAVA membership.

As I’m sure you are aware, the RCVS laid down rules about the PKS element for the AP list, and whether this could be completed retrospectively or needed to be presented at the time of application.

For those gaining their BSAVA PGCert in 2017 or later, the situation has changed (due to a decision by RCVS Council in November 2015) and the professional key skills must be formally accredited.

The PKS resources are therefore now also contained within the PGCert online learning sites for students to work through as and when they find these useful. Minor amendments to the formal assessment of the PGCerts have been agreed and will be implemented in 2017 such that PKS are now explicitly assessed alongside the existing clinical knowledge and skills (these skills were already embedded in the teaching and assessment, but this has been made more explicit). 

Getting there...

So it seems – after 10 years since the old RCVS certs were withdrawn – that we are getting there as a profession and a middle tier that is achievable from practice (your own practice, i.e. not as a resident or intern) is evolving.

The next stage is maintaining the AP status once you have got it, and how well people will get on finding 25 hours per year of certificate- level CPD plus another 25 hours of general CPD while working full-time and after their employer has just forked out approximately £10,000 for a three- to five-year course to get the AP status we will have to wait and see.

These are laudable aspirations, but not easy to fulfil. Despite the financial and time constraints, the provision of post-certificate CPD is something of a gap in the market, so just finding some is hard enough.

And if you are really lucky, you will do all that and then a major insurance underwriter will turn around and say they aren’t going to pay for clients to come and see you anyway...