ARCHIVED - Health Human Resource Connection, #4

Health Human Resource Strategies Division
Health Care Policy Directorate
Health Canada
October 2007

Welcome to the fourth edition of HHR Connection, an electronic newsletter, produced by the Health Human Resource Strategies Division (HHRSD) of the Health Care Policy Directorate of Health Canada on Health Human Resource Strategy (HHRS).

In this issue of HHR Connection, Internationally Educated Health Professionals Initiative (IEHPI) projects in Ontario, British Columbia, and Newfoundland and Labrador are highlighted and a feature on pg. 2 and 3 outlines progress related to International Medical Graduate initiatives.

Also featured online this month is HHRSD's third annual report encapsulated in two documents, the Pan-Canadian Health Human Resource Strategy Report 2006/07Accomplishments and New Projects and the Pan-Canadian Health Human Resource Strategy Ongoing Projects in 2006/07. These reports provide an overview of 26 new multi-year projects, and 46 ongoing projects under the Strategy and IEHPI.

Released in October 2007, electronic copies of the 2006/07 report are also available online.

Have you confirmed your attendance at the upcoming Health Human Resources Connecting Issues and People conference ?

Don't worry - there is still time !

This first-ever national conference, focusing on health human resource (HHR) planning and management in Canada, will highlight the connections between HHR initiatives at the national, provincial, regional and local levels. This conference will provide an opportunity for colleagues to address the diverse and challenging issues related to HHR.

The Framework is designed to help facilitate the enhancement of partnerships between the federal government and stakeholders.

In addition, the Framework is an excellent opportunity to increase communication and collaboration among government officials and stakeholders who are committed to improving health human resource planning.

Michener Institute featured on American television

On October 6th and 7th a four-minute segment on Fox 29/WUTV and WNYO's College Bound Program focused on the Michener Institute for Applied Health Sciences. The segment was filmed on campus in Toronto during September 2007.

Michener's innovative interprofessional curriculum was emphasized, along with the simulated learning environment and the school's focus on the applied health sciences. "The College Bound segment enabled Michener to be positioned as an institute for higher professional education," explained Iliana Arapis, director of Communications and Public Relations. "It provided insight to the applied health sciences and introduced Generation Y viewers to different healthcare careers."

To view a 30-second clip of the spot. The entire segment will on be their web site soon.

The program will air again for American and Canadian audiences on October 27th at 1:30 p.m. on WUTV and 7 p.m. on WNYO under the title: "Amp your Education."

Recently, the Institute was also recognized as a Top 50 Employer in the Greater Toronto Area - a first-time honour for the organization, which was also short-listed as one of Canada's Top 100 Employers.

Michener employs 250 faculty and staff whose focus is educating Canada's applied health science technologists and therapists in an interprofessional collaborative and simulated learning environment.

"We're genuinely pleased to be recognized," said Dr. Paul Gamble, president and chief executive officer.

"Our faculty and staff enthusiastically contribute to life and learning at Michener and the honour is very special for us this year as we'll be celebrating our 50th anniversary in 2008," he said.

Michener's Access & Options (A&O) for IEHPs was examined in edition #2 of HHR Connection.

Initiatives for International Medical Graduates (IMGs) Accomplishments and Highlights

In 2004, the Canadian Taskforce on Licensure of IMGs made six recommendations to address IMG barriers to licensure and practice. Through a partnership of federal, provincial and territorial governments, regulatory bodies, and academic organizations, the recommendations were examined and significant progress has been made to increase assessments, provide training, and facilitate the licensure and integration of IMGs.

"One of the things we heard from IMGs was that the process was very confusing," said W. Dale Dauphinee, former executive director of the Medical Council of Canada (MCC) and former Taskforce member.

"I think there was an overwhelming sense of frustration on the part of these graduates when they were trying to get a license," added Dr. Daniel Klass, co-chair of the IMG Steering Committee.

Both doctors agree that the situation has drastically improved for internationally trained physicians.

Partnerships within the medical community have put in place resources, which are available to IMGs before they immigrate to Canada.

One such resource is a centralized web site img-canada.ca. The site provides up-to-date information related to requirements and options for IMGs wanting to obtain licensure. Over a 12 month period (July 2006 to June 2007) web site traffic averaged 467 sessions per day.

IMGs can also use a self-assessment tool on the MCC web site, which evaluates their readiness to write the Medical Council of Canada Evaluating Exam (MCCEE). It was first available in May 2005. In 2006, 1,716 people used the online assessment tool. In 2007, 1,406 people have used the forms (January to September).

Increasing the pool of applicants has also been addressed by allowing the MCCEE to be written in more international locations. The exam can be written in centres as far away as Riyadh, Saudi Arabia; Muscat, Oman; Tokyo, Japan; Hong Kong, China and New Delhi, India.

Supported by Health Canada, the Association of Faculties of Medicine of Canada is building a capacity domestically to enhance how IMGs are taught once they enter the education system.

"The classroom now is much more diversified so there really needed to be a program to help medical faculty," said Dr. Dauphinee. The program titled Faculty Development Program for Teachers of IMGs is headed by Dr. Yvonne Steinert at McGill University. The first issue of HHR Connection includes an article talking about the program, which is being implemented across Canada.

"I think creating that program was very important because when IMGs now approach the faculty for help, they're better prepared," said Dr. Dauphinee.

"I think it provides comfort and encouragement to faculties of Medicine to take on more IMGs," added Dr. Klass.

The next challenge that IMG program directors and regulatory and certification bodies will be working towards is standardizing the IMG assessment process through a National Assessment Collaborative (NAC). The next phase will include the MCC's development of common tools to assess IMGs.

"A national assessment process for all IMGs is the one thing we're currently focusing on," said Klass. "I think Nova Scotia, Manitoba, Alberta, British Columbia and Ontario all have innovative programs for assessment but it would be nice to have something that can assess everyone under one roof."

The MCC is also developing a national process for verifying credentials, validating documents required for licensure and establishing a system to maintain records of applicant credentials.

Putting all these tools in place should ease the overall process for IMGs.

"I think we've created a system that's much more responsive," said Dr. Dauphinee.

Looking back he said he enjoyed being a part of the Taskforce. "We weren't interested in assigning blame, we wanted to create a system that would work better and try to solve problems rather than identifying them. I hope that collaboration continues across Canada and work is done to assist the people that are here that need fairly comprehensive retraining," he said.

Initiatives to address Taskforce Recommendations

Expanding and/or developing IMG preparation supports/programs

IMG Canada web site

A self-assessment tool available on the MCC web site.

A web-based orientation learning tool for IMGs on the MCC web site, which focuses on cultural, communication, legal, ethical, and organizational aspects of medicine in Canada.

Develop a capacity to track and recruit IMGs
CAPER is developing an IMG database to inform policy and program development.

The database will provide valuable insight into IMG assessment, integration and deployment.

Increasing the capacity to assess IMGs

With Health Canada funding, provinces were able to increase assessments.

In 2005, Ontario assessed over 800 IMG candidates.

The number of international locations available to write the MCCEE has expanded.

IMG Project Evaluation

Formative evaluations of the IMG initiatives funded by Health Canada are complete and feedback was very positive. A summative evaluation is underway.

Continual growth expected at Access Centre for Internationally Educated Health Professionals in Ontario

Located on Victoria Street in Toronto among the various buildings that make up the Ryerson University campus, is the Access Centre for Internationally Educated Health Professionals (IEHPs). The Centre helps internationally educated health professionals living in Ontario with information, advice and support on the process of seeking eligibility for professional practice in Ontario. The Centre officially opened its doors on December 18, 2006.

"We currently have more than 1,300 clients that come from 100 different countries," proudly stated the Centre's director Wayne Oake.

Most of our initial referrals came from the media exposure surrounding the opening of the Centre, but as we've done more outreach there's been a clear trend of referrals coming through community agencies," he said.

The Centre and its services are part of HealthForceOntario's (HFO) health human resources strategy to increase the number of doctors, nurses and other health professionals practicing across the province. The federal government committed $15.95 million to the Ministry of Health and Long-Term Care (MOHLTC) in November, 2006 for a range of initiatives to support IEHPs. The funding will continue until 2009/2010.

While the Centre provides general information for all 23 regulated healthcare professions, currently its main focus is assisting internationally educated physicians, nurses, pharmacists, medical radiation technologists, medical laboratory technologists, physiotherapists and occupational therapists.

Currently, physicians make up the bulk of the Centre's clients as part of the province's strategy to address primary health care by strengthening the integration of internationally trained medical graduates.

One of the Centre's clients, Tatiana Sochirca, worked as a physician in Moldova for 17 years before immigrating to Canada. She is currently working towards becoming a registered medical laboratory technologist.

Access Centre's Clients :
1300
(as of August 2007)



Physicians 75 %

Nurses 9 %

Pharmacists 4 %

Medical Radiation

Technologists 1 %

Medical Laboratory

Technologists 2 %

Physiotherapists 1 %

Occupational
Therapists 1 %

Other Professions 7 %

"I moved to Canada because I wanted a better future for my two daughters. My salary in Moldova wasn't enough even for food and rent," explained Sochirca.

As IEHPs register with the Centre, staff work with them to determine what will best meet their individual needs. All registered clients receive specific information on the required path to practice in their profession as well as referrals to other agencies and support from their advisor at the Centre throughout the process. Assessment of language skills and educational credentials, in addition to library resources and study groups to prepare for examinations, round out the services currently offered. The Centre is currently developing an alternative health care career program to complement these services.

IEHPs residing overseas have access to the same general information from the Access Centre as people living in Ontario. They can receive information over the phone, by e-mail or by visiting the web site.

The Access Centre makes a strong effort "to provide a clear picture of the process required for IEHPs to register in their profession in Ontario and the challenges they might expect along the way," said Oake. Moving forward, the Access Centre is developing profession-specific programs to assist IEHPs in gaining the knowledge required to become practice-ready.

Career counselling offered through the Centre has helped Sochirca realize that she can evolve within her profession, learn new specialties, and work in a field she loves. "Thanks to the Centre I still have a chance to change my future," she said.

Ontario residents can register with the Access Centre and make use of free services and resources such as:

• Centralized access to information and advice for all regulated health professions;
• Information about licensing and registration;
• Ongoing support, in person or on the phone to help clients find the most effective path to professional practice;
• On-site reference materials and resources;
• Referral to relevant organizations and community resources;
• Alternative profession options that complement the client's existing skills;
• Information and referrals for retraining and bridging training programs;
• Referral to education and assessment programs to provide timely access to the best services available, as close to home as possible.

For more information on the Centre, visit:

http://www.healthforceontario.ca/Jobs/AccessCentre.aspx


Health professions served by the Access Centre include:

Audiology and speech language pathology
Chiropody and podiatry
Chiropractic
Dental hygiene
Dentistry
Dental technology
Denturism
Dietetics
Massage therapy
Medical laboratory technology

Medical radiation technology
Medicine
Midwifery
Nursing
Occupational Therapy
Opticianry
Optometry
Pharmacy
Physiotherapy
Psychology
Respiratory therapy

Source: HFO, 2007.

Curriculum being developed for national-focused interprofessional program to help orient IEHPs to the Canadian Health Care System

According to his biography, Professor Zubin Austin has a keen interest in educational research related to the health professions, so much so that he is leading a team of program developers to create a comprehensive teaching tool that will help Internationally Educated Health Professionals (IEHPs) learn about the many facets of practicing as an interprofessional health care provider in the Canadian system.

Based out of the University of Toronto, Leslie Dan Faculty of Pharmacy, the project titled Understanding the Canadian Health Care System, Culture and Context: An Orientation Program for Internationally Trained Health Professionals is supported by $599,915 in funding from Health Canada until 2008 and will assist IEHPs in nursing, pharmacy, physiotherapy, occupational therapy, medical laboratory technology and medical radiation technology.

"Very often in response to local needs, local organizations have developed their own orientation programs and this project tries to consolidate a lot of the good work that has been done, but with a national perspective and adapted to an interprofessional teaching context," said Austin. The provinces of Ontario, Saskatchewan, Nova Scotia, and Newfoundland and Labrador are also actively involved as well as representatives from all six priority health professions.

"A lack of knowledge of the Canadian health care system by IEHPs is one of the barriers to practice consistently identified by stakeholders across health professions," added Jane Seltzer of Ontario's Ministry of Health and Long-Term Care.

Last year, the project's researchers interviewed and surveyed more than 200 people, including IEHPs, regulators, educators and employers, to determine existing learning gaps.

"Several of the IEHPs that were interviewed had gone through pre-existing orientation programs and commented that they were either very profession-specific or so generic that they were akin to an introduction to Canada," said Austin.

McMaster University professor Sue Baptiste, who provides advice on the Occupational Therapy portion of the program, says IEHPs very often need guidance in understanding the unique aspects of the Canadian health care system, such as the private-public delivery model, the ethics of practice, evidence-based medicine, standardized protocols, and confidentiality and privacy legislation, before they even enter the field. "All of these phrases have evolved within the Canadian medical community and it's a totally different language to so many people who end up here from overseas," she said.

To bridge the differences between practicing in Canada versus internationally, the teaching module will address topics that are meaningful within the Canadian context, such as communication with clients, patients, and caregivers; interprofessional collaboration and teamwork; structure and function of licensing regulatory bodies in Canada; liability issues and professional malpractice; roles and responsibilities of health professionals in Canada; patient-centred care; patient advocacy, and ethical dilemmas.

Austin said he expects to pilot the program in early 2008 using role playing simulations, face-to-face classes and web-based resources with 20 to 40 students over a 5-week period for roughly 30 hours of teaching time.

Austin said that he believes although the curriculum for the program has not been finalized, representatives on the advisory committee from various professions have expressed an interest in possibly using the program as part of their formal credential process.

"I believe at the end of the day, this program will enable internationally educated health professionals to feel more comfortable in the Canadian workplace - a factor which typically determines their success or failure as an employee. A vital competency is having the background necessary to understand how the workplace operates, the assumptions and expectations of health care providers, the roles they play and how to interact with patients and other health care professionals and this program addresses these key areas," said Austin.

For more information contact zubin.austin@utoronto.ca

Related Links

Pharmacy professor to establish program for internationally educated healthcare professionals,

News@UofT, November 2006.

Health Minister Tony Clement's speech at
Canadian Medical Association: Doctors in the House, November 2006.

Advisory Committee

Kathryn Allen
Registered Nurses Professional Development
Centre, Halifax, Nova Scotia

Sue Baptiste
Rehabilitation Science
Institute for Applied Health Sciences
McMaster University

Elaine Dever
Canadian Association of Medical Radiation Technologists

Bill Du Perron
Health and Wellness
Alberta

Tabasom Eftekari
Credentialing and Corporate Services
Canadian Alliance of Physiotherapy Regulators

Scarlet Hann
Provincial Physician Recruitment
Newfoundland and Labrador Health Boards Association

Jane Seltzer
Ontario Ministry of Health and Long-Term Care

Gulrose Jiwani
Nursing Directorate, Clinical Innovation
& Integration, British Columbia
Ministry of Health

Jessica Gallienne
Health Canada

Lisa Little
Health Human Resources
Canadian Nurses Association

Helga Loechel
Health Canada

Mary Jean Morrison
Brtish Columbia Ministry of Health

Christine Nielsen
Certification
Canadian Society for Medical Laboratory Science

Dastageer Sakhizai
Work Force Planning Branch
Government of Saskatchewan Health

Dawn Sheppard
Health Canada

Source: Dr. Austin, 2007.

Internationally Educated Nurses (IENs) being supported into post-licensure practice in British Columbia

As part of their efforts to reduce labour market shortages in priority health professions, British Columbia's Minister of Health and Ministry of Economic Development are supporting

Vancouver Coastal Health Authority (VCH), Providence Health Care (PHC) and the Kwantlen University College in working together to better integrate Internationally Educated Registered Nurses (IENs) at the post-licensure stage.

Barb Lawrie, one of the project leads with VCH, says research and anecdotal evidence from across Canada, show that IENs are struggling to be successful at work. "Our program is really about easing the transition these nurses face once employed and making the appropriate tools available in a 16-week course," she said.

"Lots of internationally educated nurses have their licenses but don't transition well. These nurses have the knowledge, but there are gaps in the translation of that knowledge into a practice setting," said Lawrie.

This project is among many initiatives for IENs being supported through a contribution of $1,464,558 between 2006 and 2009 by Health Canada. The overall outcome of this project is to establish a sustainable bridging mechanism for registered IENs in acute care, rehabilitation and residential settings.

The project was first piloted in January 2007, with eight IENs receiving four weeks of education at Kwantlen University College and 12 weeks supported entry to practice on their units. The health authorities and employers are preparing to deliver the course to 12 participants in three future intakes, with the next one occurring in October 2007.

"Many of these IENs were struggling to find work that matched their experience and were also only being hired casually," said Donna Nicholson, project coordinator with VCH. "They really appreciate having a program to support further learning without having to go back to school and start completely over."

Arlene Loico, an IEN from the first class, echoed Nicholson's sentiments. "It is indeed a great opportunity for me and I hope other foreign trained nurses are inspired to get assistance."

As part of the course, project educators, Kwantlen faculty and unit preceptors assist IENs to identify and meet any learning gaps they may have by using a variety of teaching methods, including classroom discussions, skills labs and real-world role playing in simulated environments. "Initially we use simulation labs where we set up cases for the nurses. For example, we'd simulate a situation where they might be providing care to a patient with a family in the room and the phone rings. They have to be able to set their priorities and communicate effectively in this sort of a situation," said Lawrie, noting how stressful this can be for a new employee who may still be honing new language skills. "Sometimes communication becomes challenging in a crisis and this is about supporting these nurses in a safe learning environment," she said.

During the first four weeks of the program, IENs are provided educational opportunities to review their current knowledge and skills and to identify any gaps or learning needs they may have. In the next four weeks they work on their individually identified learning needs, such as practicing pain assessments while on a designated hospital unit. For the remaining eight weeks, they are placed on the unit where they have been hired as an "additional" resource and are guided by a preceptor and one of two project educators.

"In the longer term, we will provide a variety of these tools to IENs based on their needs. Through this program, we're able to get a more accurate picture of what they need and what is critical so that they have a safe transition into the workforce," she said. "By the end of the fourth intake in 2008 the goal is to have hired and successfully transitioned 44 IENs into RN positions across both health authorities. I think it's really positive to see a project like this doing something about the barriers that these employees face and I'm hopeful that this project will inspire other initiatives," concluded Nicholson. "This kind of educational support helps these nurses, but ultimately, it will benefit patients also."

For more information, contact blawrie@providencehealth.bc.ca or donna.nicholson@vch.ca

Newfoundland and Labrador setting up a path to practice for International Medical Graduates (IMGs)

The Government of Newfoundland and Labrador's Department of Community and Health Services is developing a number of tools to improve recruitment and retention of IMGs entering the province.

Supporting this initiative is a $2,209,801 contribution running from 2005 to 2010 from Health Canada, which includes the development of an assessment tool, recruitment and orientation materials, and training modules designed to help IMG preceptors.

"We are successful in recruiting many IMGs, but retention is often a problem", said Scarlet Hann, the provincial physician recruitment coordinator at Newfoundland and Labrador Health Boards Association (NLHBA) and project lead.

To better understand the situation with IMGs, the NLHBA conducted a survey of 16 IMGs, some currently working in the province and others who had already left. Participants were asked questions, over the phone, about the welcome and orientation experiences they had when they entered practice in the province.

"When people first arrive, socialization and integration are key concerns for these graduates -needing to become part of the community, and feeling connected and comfortable enough to stay," said Hann. "How well an orientation program supports a new physician definitely influences their retention."

"Having supports for their spouses and children, along with shadowing opportunities on the job, were also highlighted," she said.

The College of Physicians and Surgeons of Newfoundland and Labrador (CPSNL) is now working with NLHBA and Memorial University of Newfoundland (MUN) to enhance their present face-to-face orientation package into a blended format, including online distance education, face-to-face learning, manuals and videos along with an online networking component.

The materials for CPSNL will include information on communication, cultural sensitivity, legislation, patient issues, addiction, and prescription writing. Fran Kirby of the Professional Development and Conferencing Services at MUN said the plan will be piloted in the spring of 2008.

"Times have changed in terms of how you would orient someone to the system and multiple formats are necessary," she said.

"These packages are being built into the provincial recruitment infrastructure so that these resources will be available well beyond 2010," said Kirby. "A continuum of orientation materials are also being developed for the province, and the four regional health authorities in the province," she said.

"Each year about a 100 IMGs come to the province for licensure through the College of Physicians and Surgeons of Newfoundland and Labrador," said Ann Marie O'Keefe-Penney of Continuing Professional Development at MUN. "We want to make this package adaptable so that it is useful for an IMG at any level of entry in their career from pre- to post-licensure."

For more information, contact Fran Kirby at fkirby@mun.ca

Stakeholders working on the Orientation Project for Newfoundland and Labrador (NL)

Dr. Cathi Bradbury, Director, Physicians Services
Government of Newfoundland and Labrador, Department of Health and
Community Services.

Scarlett Hann
Project Lead, Provincial Recruiter.

Fran Kirby
Project Manager, Memorial University,
Professional Development and Conferencing Services.

In Collaboration with:
The Association for New Canadians of NL, the College of Physicians and
Surgeons of NL, four Regional Integrated Health Authorities, and the Centre
for Collaborative Health Professional Education at Memorial University.