I liked Jennifer Fiala's April 10 article, Exam backlog has foreign-trained veterinarians in limbo. It highlights how an already stressful situation has become even worse post-pandemic. I feel for the folks interviewed.

I was born and raised in the United States; however, my background as an American veterinarian is anything but traditional. In 2010, my wife's engineering job took us to Lima, Peru. It was an adventure, but once we realized we were going to be there for the long haul, I decided to follow my dream and apply to a local veterinary school. Before I even started, I knew that if I wanted to return home to work, I'd need to jump through a few extra hoops as a foreign-trained graduate.

In 2016, about a year after graduating, I completed the Educational Commission for Foreign Veterinary Graduates program. It includes the Basic Clinical Sciences Examination, a written test; and the Clinical Proficiency Examination, a comprehensive three-day practicum. That same year, I also passed the North American Veterinary Licensing Examination, which is required of all veterinarians wishing to practice in the U.S. and Canada, as well as the California State Board Examination. The entire process was prolonged primarily due to the unavailability of seats and scheduling of test dates. Still, I finished all of the tests in the span of about a year.

I'm writing in response to a statement in the article that says, "Passing the CPE is the last of four steps laid out by the AVMA's Educational Commission for Foreign Veterinary Graduates to assess foreign candidates' readiness to take the ultimate test: the North American Veterinary Licensing Examination."

I strongly disagree. Firstly, the exams can be taken in nonsequential order; in some cases, candidates may take the NAVLE before completing the ECFVG. Secondly, the CPE is the ultimate test, and it's not a close comparison.

As a national licensing exam, the NAVLE is challenging, but it's a walk in the park in comparison with the CPE. I've heard multiple examiners at Viticus (a test center in Las Vegas) and a former examiner who's retired from practice express doubts that many entry-level graduates from AVMA-accredited programs could pass the CPE immediately upon graduation, contrary to what the ECFVG website suggests.  

The CPE demands much more preparation than the NAVLE, which consists of 360 multiple-choice questions. Spoiler alert: Life is not multiple choice. Show me two recent graduates who both passed the NAVLE but one also passed the CPE, and I'd lean toward hiring that person because I've seen what this exam entails.

The CPE format involves seven sections with several subsections, testing candidates on everything from equine lameness and bovine pregnancy checks, all the way to demonstrating ivory tower protocols for surgery and anesthesia on real canine patients. (This information is publicly available in the CPE Manual of Administration.) The CPE tests one's clinical skills and diagnostic criteria while working actual cases — the best approximation of the everyday situations that a general practitioner might encounter.

The CPE is a true assessment of one's medical knowledge and decision-making in real-life medical scenarios. Anyone who passes it should, in my opinion, be exempt from wasting time and money on the NAVLE, which serves as a baseline indication of a candidate's suitability as a veterinarian. The NAVLE does not guarantee sound medical knowledge and criteria in the real world.

After studying veterinary medicine abroad and completing an internship at an American veterinary school, I can confidently say that the quality of veterinary education at AVMA-accredited institutions is hands down the best there is. Still, I can't help wondering if the quality of veterinary medicine in our country might improve if the International Council for Veterinary Assessment, which administers the NAVLE, used a CPE-like testing format instead. 

Dr. Neshan W. Sarkisian is a self-described enthusiastic test taker who graduated from veterinary school at the Universidad Cientifica del Sur in Lima, Peru, in 2015. He completed a large animal internship at the University of Tennessee College of Veterinary Medicine in 2018, and now owns a small animal practice in Santa Ynez, California.