Gareth Cross raised an interesting and very relevant question in his article in the February issue of this publication: “What qualifications are needed to handle referrals?”
As an elected member of RCVS Council and chairman of the CertAVP subcommittee, I would like to help clarify the situation.
Gareth used the example of Huw Peplow who practises in South Devon and leads an orthopaedic referral service offering a wide range of advanced orthopaedic techniques as a vet who has no postgraduate qualifications yet regularly carries out second opinion work.
He then went on to point out the advantages of the new CertAVP in terms of its accessibility from practice, but expressed concern that they are perceived as being of a lower academic standard than the old RCVS Certificates, and therefore by implication less suited as a qualification for those seeking to take on second opinion work.
So the issues as I see it are, firstly, whether the standard of the RCVS Certificate has changed now that it is the modular CertAVP and, secondly, what qualifications are needed to handle referrals? I shall deal with those in turn.
The first point to make is that the standard of the new RCVS CertAVP has not changed from the standard that was set for the old RCVS Certificate: that of competent general practitioner. What has changed is the assessment process of the modules, which used to be carried out by the RCVS itself via its subject Boards, but has now been delegated to the universities.
This makes sense, as this is what universities are in the business of doing, and so they have quality assurance systems established to ensure their assessment is robust.
In so doing, they use the content guidelines laid down by the RCVS and the descriptors used by the universities designed to make clear the standard of work that is expected at postgraduate Masters level.
Someone taking the modular CertAVP needs to do the compulsory A professional practice module, B modules relevant to their field of work, and three C modules in any of a wide variety of subjects. Any combination of C modules can be taken, according to the needs and interests of the candidate, and the whole process can be stretched over up to 10 years.
However, if someone wants to achieve a designated CertAVP with post-nominals in a particular subject area, such as CertAVP(Equine Practice), he or she would need to select from a range of specified modules relevant to that area. In addition, for most designated Certificates it is necessary for the candidate to undertake a synoptic assessment. This is normally run by the RCVS, but can be delegated to a university where a candidate has taken the full set of modules with one institution.
The aim of the process is to ensure that candidates are able to demonstrate coherence, integration and application of learning across each subject area and between related modules, and not to reexamine the knowledge base that has already been assessed.
Gareth’s example of surgery is particularly relevant because the Surgery Board had resisted the pressure to allow designated CertAVPs in their field until they were confident that the assessment process was sufficiently rigorous.
Fascinating
The whole issue of how to assess competence in a subject that depends so strongly upon the development of skills as well as underpinning knowledge without the prohibitively expensive method of having an assessor actually watch a candidate operate, is fascinating from an educational viewpoint.
There is a big difference between factual knowledge, clinical skills and professional competence, but they are often confused. As someone whose specific field of interest is the measurement of clinical performance, I agree strongly with Gareth’s assertion that clinical audit has a major role to play in this area, and at least a basic understanding of the process is now compulsory for every candidate.
The good news is that RCVS Education Committee has now approved designated surgery CertAVPs, and it is expected that the universities will be offering suites of suitable modules in this popular area shortly.
So how does all this help the practitioner who is faced with choosing a suitable veterinarian to whom to send his or her problem case?
As Gareth points out, “As long as you make clients and referring vets aware of your level of expertise and qualifications, and don’t call yourself a specialist unless you are one, then any vet can do second opinion work.”
The standards set to become an RCVS Recognised Specialist are high, but anyone referring on that basis can be confident of making that referral to someone who is highly competent within his or her field.
The RCVS never intended that the old Certificates should be used to designate some sort of “quasispecialist”, although in some fields more than others there may have been a tendency in practice for that to happen. This has in turn driven an upward spiral in the level of assessment of the old Certificates in some subjects, making them very difficult for a general practitioner to achieve.
The referring veterinarian has a professional responsibility to be confident that the person to whom he or she is making a referral is likely to be competent to handle the case, and similarly, a veterinarian in any circumstance should not take on the management of a case that falls outside of his or her ability, except sometimes in the short term management of an emergency situation.
If a practitioner refers to an RCVS Recognised Specialist in the area relevant to the case referred, it is pretty much inconceivable that he or she could be accused of malpractice. Where the vet taking the referral is not a Recognised Specialist, the situation is less clear cut, whether he or she has an RCVS Certificate or not.
The onus would be upon the referring vet to know enough about the vet concerned to be confident that he or she is suitable to take the case, and the vet who takes the referral must ensure that there is no misunderstanding with both the referring veterinarian and the client about the level of expertise.
If the veterinary surgeon acted outside his or her area of competence, both parties could be held liable for any negative consequences either in a civil action for negligence or, in extreme circumstances, before the disciplinary process of the RCVS.
Misrepresentation
In addition, veterinarians who hold themselves out as any sort of specialist without being able to substantiate such a claim could also be sued for misrepresentation.
The whole concept underpinning the RCVS Certificates, both old and new, is to try and raise the standard of general practice by providing a framework to encourage professional learning and development.
The old Certificate did much to lay the ground, but in an age where flexibility is at a premium, the new modular structure is already proving a great success with many and promises to become the “norm” for professional development in the future.
Just as it is expected that GP medics will progress to take their MRCGP qualification, so it is hoped that the learning process for graduates old and new will follow down the route of the new RCVS modular CertAVP.
A great deal of information on the modular Certificate can be found at www.rcvs.org.uk/modcerts.
