When I graduated from veterinary school back in ’95, every single member of our class passed the NAVLE (the North American Veterinary Licensing Examination) before graduating. It was so uncommon to fail and I recall being floored after learning one classmate had failed on her first attempt. If we had taken a “most likely to succeed” vote, she would have clinched it.
Three decades on, this NAVLE-failing veterinarian’s sterling career has done little to dispel my faith in her abilities. Nevertheless, I have consistently harbored an ongoing bias against first-time NAVLE fails. Despite personal experience to the contrary, I have always side-eyed those who could not pass the one test none of us has a right to fail if we expect a license to practice.
There it is, my prejudice, in all its ugliness. For 29 years that has been my bias. I would dismiss any applicant who had not yet passed and, more recently, assumed reports of higher fail rates among test-takers likely indicated poor preparation (especially when it happens at newer institutions) and a spiraling decline in candidate quality overall.
This year, however, something happened to alter that perspective. I met someone who failed not just once…but twice.
Failing to pass
This past spring, I was fortunate enough to hire a candidate we mentored in her pre-vet days. She had taken the NAVLE—for the second time—two months before coming aboard as a new associate.
She was practicing legally while awaiting her test scores, as is her right in the state of Florida. During that time, she won over every client with a winning personality. She was willing to patiently abide meandering histories, offered impressively lucid explanations, and—above all—confidently projected she knew what she was talking about. At the end of her first week, she claimed to have had the best week of her life. It was a moment so heartfelt even this jaded veteran had to grab a hankie.
By the second week, however, she was the one in tears. She had received the letter documenting her NAVLE score. She had failed … by just four points. In case you do not remember, a passing score is 425, and there is no way to appeal.
For those who fail the test and find themselves doom scrolling the internet for worldly advice, the website for the International Council for Veterinary Assessment (or the ICVA, the NAVLE’s administrator) is the most obvious destination. For those already employed in practice, it will direct you to your State Board for instructions on what to do should you fail to pass and still hope to practice.
Helpfully, the ICVA’s FAQ page also offers a variety of career alternatives you might elect in case the NAVLE’s bar remains permanently elusive (i.e. the Armed Forces, research, the USDA, etc.). It is not the most uplifting reading for would-be small animal practitioners acutely in need of solace.
Why they fail
I used to think NAVLE fails were all knowledge-based, but that did not make sense in our associate’s case. After a couple of weeks in practice, it was obvious her memory bank was full and the speed was kicking. She could scan reams of lab work and identify all the crucial issues, linking them back to physical exam findings and historical details for an easy A on applied recall of anatomy, physiology, and pathology.
Sure, she was weaker on identifying abnormalities on physical exams and could not infuse an anal sac to save her life, but how could someone fail the NAVLE when they know all the bookish bits forwards and back? Sigh …
So why do they fail? It is multivariable and varies widely, of course. In our associate’s case, it came down to extreme test-taking anxiety. The first time around she was wholly unprepared for the stress and spent minutes at a time panicking in between questions. The second time she had acquired more confidence in her knowledge and a few stress-taming skills, but the first experience had left her rattled and not in the best frame of mind for another go-round.
Testing anxiety is increasingly credited for many of this generation’s declining standardized test scores. In fact, testing tutors, who specialize on high-stakes standardized tests, identify stress—not knowledge—as the primary obstacle for those who consistently fail by just a few points. Additionally, it can be easy for these candidates to continually fall flat when they concentrate on upping their scores with more assiduous study rather than by learning to better manage their testing stress.
What happens after a fail?
I always wondered what happened to those who took the test, took a job, and received their test scores only to learn they had failed. Here’s what happens:
If you fail the NAVLE, you do not get a veterinary license. Period. In some states, you can secure a temporary or conditional license until you do pass (you get five tries in five years and can appeal to get one more try thereafter). In others, you can practice only under direct supervision while technically without an active license.
In our state there is no margin for error. If you fail, you cannot practice at all. The best you can do is work as a veterinary assistant until you retake your exam, at which point you can work as a veterinarian (if someone will agree to take you on) until you receive your test scores two months down the road.
In recent news…
Recent years have seen troubling declines in NAVLE test scores. As it stands, only 86 percent of fourth years passed in 2022-2023, down from 90 percent in 2021-2022, 92 percent in 2020-2021, and 95 percent in 2019-2020.1
The steep decline has prompted industry insiders to ask questions about our schools’ admissions and curricula. Is the distributed learning model to blame? Was this a side effect of COVID-style education? Are we minting the increasingly unprepared? Do our admissions policies and class sizes need to be reconsidered? Is the test itself a factor? Or is this a product of our culture and more a question of our test takers’ mental health?
Some schools are suffering more than others. In the case of the fledgling University of Arizona,2 the issue is even more acute. Will they fail to gain their accreditation given that only 72 percent of their inaugural class passed last autumn’s test? (An 80 percent threshold is required for accreditation.)
Assessment experts across a wide variety of professions are evaluating all the possibilities. After all, it is not just a NAVLE problem, it is affecting other health professions’ standardized tests, too. Significant declines have even been observed at the SAT and ACT level over the past few years.3,4
What’s next for our associate and others like her?
When we hired her, we knew she was waiting for scores. Because she was so dear to us (and because we have complete faith in her), we readily agreed to assume the risk. Now that she is part of the family, we are committed to her success—perhaps more so now we are witnessing firsthand how much grit and passion she’s got.
For her and so many others, however, it will be a tough slog. Not only does she have to study for the NAVLE, but she also is enrolled in a grueling tutoring program (one that addresses testing stress, too) while working full-time in what is legally considered a veterinary assistant’s role. To make matters worse, she earns veterinary technician pay (the highest we offer, but still, a far cry from a veterinary salary). How is a loan-saddled vet grad supposed to survive under these conditions?
There is a bright side, though. When it is harder to achieve your goals, you tend to value them more. A little hardship has a way of paving the way to gratitude. However, there is a limit to what we should be expected to endure after four otherwise successful years in a veterinary program.
Patty Khuly, VMD, MBA, owns a small animal practice in Miami, Fla. and is available at drpattykhuly.com. Columnists’ opinions do not necessarily reflect those of Veterinary Practice News.
References
- https://www.avma.org/news/number-navle-test-takers-increase-overall-scores-decrease
- https://news.vin.com/default.aspx?pid=210&Id=11789099&f5=1
- https://www.npr.org/2023/10/12/
1205404298/act-test-scores-college-admissions-30-year-low - https://cardinaltimes.org/20322/news/the-decline-of-the-sat-and-act/