Clinical Competencies

Graduating students at CVM must attain professional competencies defined by the AVMA.

AVMA Statement on

Competency Outcomes

Veterinary graduates must have the basic scientific knowledge, skills and values to practice veterinary medicine, independently, at the time of graduation.  At a minimum, graduates must be competent in providing entry-level health care for a variety of animal species.

During the DVM curriculum, students will be required to demonstrate competency in a range of skills and activities, including but not limited to diagnostic and examination skills, anesthesia, surgery, animal handling and husbandry, communication, ethics, and clinical reasoning.  These activities are threaded and assessed throughout the curriculum. 

In addition to these activities, students are required to complete the following activities:

• Attend one approved diversity training experience (i.e. Cultural Awareness Seminar) each of the first three years of veterinary college and submit a reflection statement. 
• Complete one approved research-related educational experience before graduation. 

More information about how to submit reflection statements and meet the research requirement can be found here:  https://moodle-projects.wolfware.ncsu.edu/course/view.php?id=8709

Map of Current Competencies

Understand How What You do Meets AVMA Required Outcomes

NC State College of Veterinary Medicine has created a comprehensive document that maps the relationship between NC State’s required clinical skills, the college’s goals and the AVMA Statement on Clinical Competencies Outcomes. Review the document here  

Competency Tracking and Progress

Students are responsible for tracking their progress in meeting each competency requirement. Advisors are responsible for signing off on students’ clinical competencies.

In the 4th year, advisors and students meet before December 15 (the date when Academic Affairs starts checking the database) to determine if there are any requirements remaining to be completed and devise a plans, if necessary, to make sure that ALL skills are signed off by March 15. Students’ completed clinical competency books must be submitted to the Office of Academic Affairs by March 15. A completed book is required for graduation.

Track Progress via the Online Clinical Competency Tracker (current students only)

Download competency books for each class

Current Clinical Competency Requirements

Once enrolled, students receive the specifics for requirements for their graduating class. Following is a general overview of what is expected, although there may be small variations from year to year. Skills must be signed off by an NC State faculty or staff member unless a practice training program has been approved or the skill is starred. Approved practice training programs are listed in the competency books.  Starred skills may be signed off during any extramural practice experience.

General Guidelines

Skills must be signed off by an NCSU faculty or staff member unless a practice training program has been approved or the skill is starred. Approved practice training programs are listed in the competency books. Starred skills may be signed off during any extramural practice experience.

Every Veterinary Student must get the Following signed off:

• Act as primary surgeon for at least 10 surgical procedures, including feline castration, feline spay, canine castration, and canine spay.
• Attend one approved diversity training experience (i.e. Cultural Awareness Seminar) each of the first three years of veterinary college
• One research-related educational experience before graduation, including those students with a graduate degree.

Core Skills – 90% of the Skills Listed Below Must Be Completed Before Graduation

Husbandry/Restraint/Routine Client Education

Physical Exam

• Orthopedic (lameness) exam on a small animal patient and a horse, including naming and identification of all major joints, recognizing normal angles and range of motion for major joints and the hoof, use of a goniometer, use of a hoof tester , use of a hoof pick, use of a hoof gauge, flexion tests, thigh circumference measurement in dog
• Neurologic exam small animal patient, horse, must demonstrate:
  • Patellar reflex
  • Withdrawal reflex
  • Panniculus reflex
  • Deep pain assessment
  • Menace response
  • Palpebral reflex
  • Pupillary light reflex
  • Conscious proprioception
  • Hopping Bladder palpation/expression
• Ophthalmic exam, including use of direct and indirect ophthalmoscope, ocular pressure measurement, small animal patient, horse. Must demonstrate:
  • Menace response
  • Pupillary light reflex
  • Dazzle reflex
  • Schirmer tear test
  • Fluoroscein staining
• Dermatologic exam, as appropriate for patient, Must demonstrate:
  • General dermatologic exam
  • Recognize primary and secondary dermatological lesions
  • Otic examination
  • Skin scrapings – deep / superficial
  • Skin cytology – tape/swab/aspiration
  • Otic cytology
  • Appropriate methods of collection of samples for bacterial / fungal culture
  • Woods lamp examination>
  • Trichogram
• Cardiovascular exam, including identifying, describing, and assessing the clinical significance of transient heart sounds and murmurs, examining arterial and venous pulses, obtaining a resting standard 6-lead EKG, accurately measuring noninvasive arterial blood pressure in small and large animal patients
• Oncologic exam, including identification of peripheral lymph nodes in the dog or cat and performance of fine needle aspiration of a lymph node or mass
• Reproductive exam:
  • Obtain and interpret a vaginal smear in the bitch.
  • Conduct a pregnancy exam on a bovine, equine, and canine female.
  • Prepare and evaluate semen from either a stallion, bull, or a stud dog.
  • Conduct an examination of the external genitalia of the intact bovine, canine, and equine male and female.
  • Properly describe and correct malpresentations, positions, and postures in a case of bovine or equine dystocia. They should also be able to place obstetrical chains properly on either the fore or rear limbs of a bovine or equine fetus

Sample Taking

• Obtain a blood sample dog, cat, horse, cow, sheep, pig, one bird species, one reptile species, one small mammal other than dog or cat, one other species of your choice.
• Collect blood using needle and syringe
• Collect blood using vacutainer.
• Obtain a urine sample using catheterization
• Obtain a urine sample using cystocentesis
• Obtain a milk sample from a cow for mastitis evaluation
• Obtain a fecal sample
• Obtain a cloacal culture (bird)

Radiology, Necropsy, Clinical Pathology, Parasitology

• Perform radiographic exams for 5 patients (position, create, process, interpret radiographs)
• Perform complete necropsy on two mammalian species, one species of choice.
• Collect samples appropriate for 1) biopsy submission from 3 tissue types, 2)microbiological sampling, 3) toxicologic sampling.
• Be able to select a pig from a group for post-mortem examination. In the pig, be able to identify major lymph nodes, tonsils, area of lung most affected by pneumonia, sites of ulcers.
• Process a blood sample (PCV, TS, glucose, BUN, prepare and stain a blood smear, do a blood smear differential, estimate platelet count)
• Process a urine sample (reagent strip, specific gravity, sediment exam)
• Examine a fecal sample for parasites (direct smear, McMaster’s technique, centrifugation, double centrifugation)
• Microfilaria ID in blood drop
• Microscope technique specific to parasitology  specimens
• Perform an ELISA test

Basic Medicine Skills, Experience, Problem Solving and Case Management

• Obtain a complete clinical history for 5 patients. Obtain client histories with clinician supervision, demonstrating appropriate body language, eye contact, appropriate language, respect for client’s emotions and view of the problem.
• Define “chief complaint” and create a prioritized problem list for 6 patients, including one special species patient.
• Based on the patient’s problem list, make a differential diagnosis list for 5 patients, including one special species patient.
• Based on the patient’s differential diagnosis list, choose the appropriate diagnostic tests for 5 patients.
• Create a problem-oriented medical record for 5 patients, demonstrating ability to organize and succinctly state facts and opinions with correct spelling and punctuation.
• Provide oral summary of 5 cases for peers, demonstrating organization and precise language
• Create laboratory flow sheet for 2 individual animals, demonstrate case management using flow sheet
• Follow 5 patients through treatment of a problem
• Discuss case progress with 5 clients, demonstrating ability to address client concerns, to discuss financial matters, empathy with client, appropriate boundaries with client
• Provide oral discharge instructions for 5 clients, demonstrating solicitation of client feedback to assure that the instructions are understood, solicitation of client’s point of view and concerns regarding ability to provide treatment, appropriate demonstration of techniques
• Write 5 discharge instructions, demonstrating ability to organize and succinctly state facts and opinions with correct spelling and punctuation
• Perform follow up phone calls on 5 patients to assure problem resolution or need for continuing diagnostics/therapy
• Participate in medical primary care clinic at least 5 days (wellness clinic, shelter, vaccination clinic, practice)
• Participate in the management of at least 5 medical referral patients (any species)
• Evaluate, workup and properly record a case involving a population of animals.
• Demonstrate oral administration of medications horse, ruminant, dog, cat, one bird species, one reptile species, one small mammal other than dog or cat, one other species of your choice. Includes demonstrating tablet administration, or the use of an oral dose syringe, as appropriate.
• Demonstrate SC administration of medication large animal, small animal, one bird species, one reptile species, one small mammal other than dog or cat, one other species of your choice
• Demonstrate IM administration of medication large animal, small animal, one bird species, one amphibian/reptile species, one small mammal species, one other species of your choice. Includes being able to show landmarks for muscle groups, knowing muscles used in food animals, knowing pros and cons of each injection site. Specifically be able to discuss sites used for vaccines, large volumes (procaine penicillin in the horse), iron shots in pigs.
• Demonstrate bolus IV administration of medication large animal, small animal, other species of choice. Be able to discuss how to manage perivascular injection of a caustic material.
• Choose, calculate amounts and administer intravenous fluids to 7 animals, including one small mammal.
• Place IV or IO catheter in 1 bird and 1 amphibian/reptile and calculate fluid amounts for 1 avian and one amphibian/reptile patient.
• Choose and calculate correct drug dosages for 8 animals, including one patient receiving constant rate infusion drugs and one bird species, one amphibian/reptile species, one small mammal other than dog or cat.
• Write 5 outpatient prescriptions in a format that would allow them to be filled at a compounding or human pharmacy
• Administer 5 controlled drugs, keeping correct records for each drug.
• Be able to load and operate a projectile drug delivery device (blow gun, air rifle, pole syringe)
• Demonstrate ability to evaluate and suggest treatment for a common behavioral problem, such as feline house soiling.
• Articulate the rationale for recommending a given diet for a given disease state.

Anesthesia and Pain Management, Patient Welfare

• Identify parts of an anesthesia machine
• Put together a circle system
• Put together a non-rebreathing system
• Place IV catheter in 3 small animals (dog, cat, small mammal)
• Intubate 6 small animals, including at least 2 cats. Intubate or assist intubation of one bird species, one reptile species.
• Place blood pressure, ECG, and pulse oximetry monitors on 3 patients
• Perform anesthesia on 5 small animals, including record keeping and demonstrating knowledge of monitoring equipment, anesthesia/analgesia
• Perform anesthesia or sedation on a small mammal.
• Perform anesthesia on 1 large animal, including record keeping and demonstrating knowledge of monitoring equipment, anesthesia/analgesia
• Calculate and administer constant rate IV drug infusion.
• Design pain management/anesthesia regime for 3 small animal surgical patients
• Design pain management/anesthesia regime for 1 large animal surgical patient
• Design pain management/anesthesia regime for 1 special species patient
• Design chronic pain management treatment (any species)
• Perform pain scoring on 5 patients (any species)
• Perform 3 local analgesic blocks on any species. Be able to demonstrate the landmarks for commonly used local blocks (dehorning, standing procedures in ruminants, declaw surgery in cats, etc)
• Perform 1 epidural on any species
• Participate in one euthanasia (any species) and explain indications and methods of euthanasia, including methods appropriate for zoological species commonly seen in practice
• Educate one lay person on an animal welfare issue

Dentistry

• Dental exam on small animal patient, including charting of lesions
• Dental exam on a large animal patient, demonstrating the ability to age a horse and a cow by its teeth. Know eruption times used for aging immature animals.
• Demonstrate canine or feline dental cleaning and extraction

Basic Surgery Skills, Experience, and Case Management

• Demonstrate knot tying (square knot, friction knot, one hand tie, two hand tie, instrument tie)
• Demonstrate correct instrument handling (three point grip, pencil grip, suture cutting)
• Demonstrate basic suturing techniques (simple interrupted, simple continuous, Connell, Cushing, Lembert, Ford interlocking, horizontal mattress, vertical mattress)
• Demonstrate pack preparation
• Demonstrate patient preparation
• Demonstrate sterile technique (scrubbing, gowning, gloving, draping, ability to keep a sterile field)
• Demonstrate wound closure, stent use, placement of mattress sutures
• Demonstrate drain placement
• Demonstrate bandaging techniques, small animal
• Demonstrate emergency bandaging techniques, large animal
• Demonstrate bandaging of an open wound (wet-dry bandage).
• Demonstrate suture or staple removal
• Act as primary surgeon for at least 1 feline castration, 1 feline spay, 1 canine castration, 1 canine spay and the required number of additional, other procedures (consult your class competency requirements for specific requirements/numbers) . The feline castration, feline spay, canine castration, and canine spay must be signed off by an NCSU faculty member. The remaining surgeries can be signed off by any supervising veterinarian. (LIST SURGERY PROCEDURES AND THE DATE AT TIME OF SIGN OFF.)
• Participate in the management of at least 5 surgical referral patients (any species)

Emergency and Intensive Care Case Management

• Demonstrate thoracocentesis in small animal patient
• Demonstrate abdominocentesis
• Demonstrate tracheostomy
• Demonstrate administration of nasal oxygen
• Demonstrate technique for gaining emergency venous access
• Demonstrate CPR for a small animal patient
• Demonstrate working knowledge of cardiac resuscitation drugs and goals for a small animal patient
• Outline steps for resuscitation of either a large or small animal in hypovolemic or septic shock including: goals of therapy, fluid therapy (choice of fluid, rate and amount, IV catheter choice), drug therapy and monitoring response of therapy.

Health Promotion, Disease Prevention, Zoonosis and Food Safety

• Health promotion/disease prevention
• See restraint/husbandry/routine education/TAU sections
• Demonstrate ability to educate lay person(s) on 5 zoonotic diseases including at least one that involves zoological species*
• Demonstrate ability to educate lay person(s) on 5 diseases transmitted by food, the role of the veterinarian in preventing transmission, and the precautions the lay person should take*
• Design a population based disease control or prevention plan.
• Demonstrate proficiency in planning and execution of a simulated or real outbreak investigation.
• Be able to articulate and provide examples of how veterinarians in public practice promote and protect public and animal health.
• Evaluate a veterinary clinical facility for environmentally responsible clinical practices including disposal of discarded therapeutic agents, energy conservation, and emissions/discharge management.*
• Evaluate a facility housing large numbers of animals (shelter, farm, zoo, lab animal) for environmentally responsible practices including waste disposal, human/production animal/wildlife interactions, energy conservation, and emissions/discharge management. *
• Fill out and complete a Coggins test form
• Complete a health certificate
• Complete Credentialed Responder Training
• Complete required sections of Emerging and Exotic Diseases of Animals (EEDA) and USDA Initial Accreditation Training (IAT) online learning modules
• Complete Certified Rabies Vaccinator Training

Client Communications and Ethical Conduct

• Present one ethical dilemma facing an individual veterinarian or the profession, demonstrate ability to choose a position based on system of values
• Demonstrate the ability to educate lay person(s) on an ethical or welfare issue
• Written Communication: See Medicine skills
• Oral Communication: See Medicine skills, Animal Welfare
• Client sensitivity/Grief counseling: Participate in counseling of a client that has lost an animal or explain stages of grief and techniques for helping client deal with loss*
• Teamwork: Be a member of 5 teams and receive passing grades for team participation skills
• Conflict resolution: Present one legal/conflict issue, demonstrating knowledge of the legal issue, both points of view in conflict, suggest possible resolution
• Diversity Training: Attend one approved diversity training experience (i.e. Cultural Awareness Seminar) each of the first three years of veterinary college

Strong Appreciation for the Role of Research in Furthering the Practice of Veterinary Medicine

• Each DVM student is required to have one research-related educational experience before graduation, including those students with a graduate degree. Such experiences could include, but are not limited to:
• Being in the Clinician Scientist Focus Area, with completion of its research requirements.
• Performing a summer of approved research at NCSU or another institution. (Previous research work will not qualify.)
• Research thesis option within Zoological Medicine Focus Area
• Successful completion of a research-related selective (i.e. Intro to Research at the CVM, Molecular Medicine Initiative selectives, research selectives personally arranged or already existing such as Advanced Pathology)
• Attending a research-related conference and supplying a three-page report to your advisor on the experience.
• Attending the annual CVM Research Forum and supplying a three-page report to your advisor on the experience.
• Attending a research seminar at the CVM, elsewhere at NCSU or at another institution and writing a three-page report on the seminar and one related publication. (Attending clinical conference is not included.) Hand in the report to your advisor.
• Writing and submitting a research proposal to an extramural funding agency.
• Research experiences in Special Topics courses (i.e. Swine Medicine).
• Being an author on a research paper (not a case report) while in veterinary college

The Following Skills Are Checked Off in Health Maintenance and Animal Production I, Ii, Iii in the Teaching Animal Unit

Equine

• Approach, catch and halter a horse
• Lead and turn a horse at the walk
• Lead a horse at the trot
• Pick up and hold a forelimb and hind limb of a horse
• Groom a horse
• Use hoof testers
• Tie a quick release knot
• Use a weight tape
• Perform physical exam on adult horse
• Perform physical exam on neonatal foal
• Perform ocular exam
• Place nose twitch
• Perform skin fold twitch
• Perform ear twitch
• Place chain shank over nose
• Place chain shank over lip
• Complete written physical exam form
• Collect blood into a vacutainer
• Collect blood using a needle and syringe
• Administer an oral medication
• Administer an intramuscular injection
• Administer an intravenous injection
• Administer a subcutaneous injection
• Fill out and complete a Coggins test form
• Complete a health certificate
• Perform lameness exam (including all flexion tests)
• Perform neurological exam (including cranial nerve and movement exam)
• Pass nasogastric tube

Cattle

• Tie a quick release knot
• Cast a cow with a rope
• Perform a Physical exam
• Identify methods of identification of animals
• Body condition scoring and relation to life cycle
• Collect blood sample from jugular
• Collect blood sample from the tail vein
• Perform and interpret a TB test
• Injection site identification (Beef Quality Assurance)
• Identify and perform an intramuscular injection
• Identify and perform an intravenous injection
• Identify and perform subcutaneous injection
• Identify needle sizes for IM, SQ, and IV injections
• Administer an oral bolus to at least 2 cows
• Pass a stomach tube and administer oral fluids
• Processing calves:
  • Know how to perform all procedures
  • Actively perform at least two procedures (tattooing, castration, dis-budding, implanting)
  • Pregnancy check > 5months
  • Collect a sterile milk sample
  • Perform a CMT test
  • Interpret a CMT test
  • Properly use a hoof knife
  • Restrain and lift a foot for trimming or lameness evaluation

Sheep/Goats

• Know and use FAMACHA system for parasite control
• Blood collection from jugular vein
• Identify jugular landmarks, lung fields, rumen location
• Determine age of goats or sheep
• Perform vaccinations
• Perform intramuscular injection (identify sites)
• Perform subcutaneous injection (identify sites)
• Perform a foot trim

• Body condition score a goat or sheep
• TB test a goat or sheep
• Disbudding procedures and nerve blocks (goat only)
• Perform an ultrasound pregnancy diagnosis
• Interpret an ultrasound diagnosis
• Interpret ultrasound pregnancy diagnosis
• Perform a physical exam
• Restrain a sheep or goat
• Administer an oral medication to a sheep or goat

Swine

• Safely restrain suckling, nursery, and finisher pigs
• Safely move nursery or finisher pigs between pens or sort within pen
• Identify which TAU pig housing facilities are for what age groups
• Interpret average/expected litter size data
• Be able to list pros and cons of breeding herd housing systems
• Identify the major feed ingredients in pig rations
• Describe and recognize normal feeding behavior

• Perform pregnancy diagnosis in female pigs using different methods
• Identify signs of estrus in the female pig
• Complete physical examinations on individuals and groups of pigs
• Restrain and collect blood from nursery and/or finishing age pigs
• List the key criteria for selection of optimal pigs for diagnostic testing
• Identify these key diagnostically significant anatomic structures:
• Tonsils, turbinates, region of stomach prone to ulcers, ileum, spiral colon, lung lobes, lymph nodes

Poultry

• Catch and safely restrain a turkey for physical examination
• Catch and safely restrain a chicken for physical examination
• Perform a basic physical examination on turkey
• Perform a basic physical examination on a chicken
• Evaluate general health status of a turkey flock
• Evaluate general health status of a chicken flock
• Perform a cloacal swab on a turkey
• Perform a cloacal swab on a chicken
• Perform a tracheal swab on a turkey
• Perform a choanal swab on a turkey
• Collect a blood sample via wing vein on a turkey
• Collect a blood sample via wing vein on a chicken
• Perform a subcutaneous injection on a turkey
• Perform an intramuscular injection on a turkey

Each Focus Area Will Determine Required Tasks for Students in the Focus Area