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The ‘B’ module for an RCVS Certificate

by
01 November 2009, at 12:00am

Dr GRAHAM DUNCANSON continues the series on the new CertAVP and the work involved

FOR me, the ‘B’ module is the most enjoyable part of the certificate. I am a clinician and the ‘B’ module is all about one’s clinical learning from five case studies. 

It is logical that this module follows the more general ‘B’ Zero essay, which should contain discussions on first aid and euthanasia in all species. It should also contain evidence of learning on notifiable diseases and zoonoses in all species. 

The ‘B’ modules can cover a wide spectrum of learning from laboratory animals to public health. However, the three we are interested in at VetLearning are Small Animal Practice (SAP), Production Animal Practice (PAP) and Equine Practice (EP). These are new concepts except in Equine Practice.

Highly thought of 

The old CertEP was the most successful of the “old type” certificates. It had the highest completion and pass rate of all the certificates. It is extremely highly thought of in the equine sphere not only in the UK but also world-wide. 

The RCVS has been wise in not only continuing with suchacertificate but also by adding the Small Animal and Production Animal modules. Historically, small animal practitioners and farm animal practitioners were envious of their equine colleagues. 

The three ‘B’ modules, SAP, PAP and EP, are in essence the same. The only difference is the species. However, the old CertEP required 10 perfect equine case reports. These had to show that the participant had carried out a perfect diagnostic work-up followed by a perfect treatment plan. 

In the sad event of failure, the case report would require a full post mortem. These case reports were, therefore, virtually impossible for the clinician in general practice. 

They were much more realistic for the practitioner in referral practice or attached to a veterinary school. Hence, the vast majority of these old CertEPs were not completed by general practitioners. 

Often the reason for the lack of completeness of these case reports was the lack of funds by the owners. It might be argued that in the present day, when insurance is much more widespread, this would not be a problem. 

Sadly, this is not the case as more sophisticated diagnostic tools are now available, e.g. MRI and CT. These do not come cheap and invariably exceed the insurance funds available for a normal riding horse. 

Once again the RCVS has taken a bold, but very justifiable, step in making these case studies, in all three disciplines, rather than case reports. I would emphasise that this in no way lowers the level of the modern certificate from the old certificate. 

Case study v. case report 

There is a very marked difference between a case study and a case report. The veterinary surgeon taking the new certificate has to grasp the essential difference. The case study does not have to have a perfect diagnostic workup or treatment plan. 

The candidate has to demonstrate that he or she is aware of all these diagnostic tools and all the treatments which are available. However, the candidate is quite at liberty to state why the so-called “gold standard” was not carried out. 

The candidate has to discuss all the reasons for such omissions and more importantly has to reflect in-depth on the learning achieved by carrying out the investigation and treatment in the “real world” of first opinion practice.

So, having confirmed that the modern certificate is as high a standard as the old certificate, how can I say that it is so enjoyable? I derive great satisfaction in learning. In my world, learning is achieved by doing. Naturally I have to do extensive reading around the subject.

This reading, however, has a real purpose to further my knowledge on the particular case in hand. It is not just general reading or parrot-like studying to retain information to then regurgitate. 

The references required to be followed up may be extensive but provided they are exactly recorded at the time this is not a difficult task. The so called “literary review” is a natural progression to understanding the case. The case becomes a study, not just a report. My learning does not end with the literary review. The opportunities for learning are enormous. 

How successful was I with my communication with the clients? How did I manage the finite resources available to me? How did I make the best use of more experienced colleagues? These colleagues may have been working for longer, or they may have seen more of these types of problems or they may actually have been specialists. 

More extensive 

In any event, I will reflect how I would utilise their help better in the next case. I would tabulate these areas of learning in my study. It is very likely that my learning will be much more extensive in the cases which have not been straight forward or have not “gone to plan” or frankly have been disasters. 

I will be sad for the patient and sad for the client but I will be able to move on with the satisfaction that the next similar situation I will handle in a different and, hopefully, in a more successful manner. 

By recording cases and studying them, I will be carrying out in my own very limited arena, dare I say it, evidenced-based medicine. Obviously, if I stick to a certain different treatment plan in enough cases,Iwill be carrying out simple clinical audit.

To conclude, I consider the carrying out of a strong case study to be one of the most enjoyable aspects of veterinary practice. Certainly, the enjoyment makes practice rewarding. It is doubly rewarding receiving a further qualification as a result. 

I am a large animal practitioner doing regular farm animal and equine work. There is nothing to prevent me doing a ‘B’ module in Production Animal Practice and a second in Equine Practice. 

For those of you in true mixed practice, there is no reason not to do a ‘B’ model in Small Animal Practice as well. Therefore, there is a win-win situation. Better treatment for the animals under my care. Improved client satisfaction. 

Certainly improved job satisfaction and, dare I say it, improved monetary reward.