1. Access Issues Regarding Internationally Educated Health Professionals and the Respiratory Therapy Profession in Canada Prepared for presentation at NARTRB Learning Days January 23, 2009 Presented by: Paulette Blais, P. M. Blais Consulting Services

2. Background Project was developed by National Alliance of Respiratory Therapy Regulatory Bodies (NARTRB) The NARTRB Partners at the time were: – College and Association of Respiratory Therapists of Alberta (CARTA) – Manitoba Association of Registered Respiratory Therapists (MARRT) – College of Respiratory Therapists of Ontario (CRTO) – Ordre professionnel des inhalothérapeutes du Québec (OPIQ) – Canadian Society of Respiratory Therapists (CSRT)

3. Background Project funded by the Canadian government's Foreign Credential Recognition (FCR) Program. Research undertaken between September 2007 – January 2008 Guided by a Steering Committee of: – NARTRB partners – the Canadian Advisory Council for Education in Respiratory Therapy (CACERT) – an internationally educated respiratory therapist currently registered and working in Canada – an employer representative

4. Purpose Provide an overview “diagnostic” of the RT profession in Canada and the issues associated with internationally educated health professions (IEHPs) seeking professional registration as RTs in Canada. Identify the challenges faced by applicants and regulators as IEHPs apply to enter the profession in Canada. Identify the strengths and opportunities within the RT profession to meet these challenges. Develop recommendations to facilitate access to the RT profession for IEHPs.

5. Methodology Data collection through: key informant interviews with regulators, educators and other stakeholders in regulated provinces (Alberta, Manitoba, Ontario and Quebec); key informant interviews with CSRT staff; interviews with IEHPs and IERTs going through or have completed the registration process in BC, Alberta and Ontario; focus group with IEHPs who have completed registration in Quebec; an on-line survey of CRTO prior learning assessment (PLA) candidates; collection of demographic info. from regulators regarding applicants; research and review of legislation in key non-regulated provinces; collection of graduate data from approved RT programs across Canada; review of labour market data available from the Canadian Institute of Health Information (CIHI); on-line employer surveys conducted in Alberta, Manitoba and Quebec; an employer focus group in Alberta; review of successful initiatives in promoting access to registration for internationally educated professionals in other fields.

6. Scope of the research First phase of the larger HRSDC FCR program: – research and information gathering, such as collection of data on the current situation of RTs with respect to occupational demographics, education, regulatory standards, etc. Information re. registration process and applicant data gathered from regulated jurisdictions: Alberta, Manitoba, Ontario & Quebec. Included data re. applicants educated outside of Canada and U.S.

7. Findings Number of applications from IERTs and IEHPs each year is quite small; even Ontario and Quebec reported receiving fewer than 20 internationally educated applicants per year. Of the almost 8,000 registered respiratory therapists in Canada, there were only 19 RTs registered in Canada who completed their original education outside of Canada or the U.S.

8. Findings (cont’d) Three common features of most internationally educated applicants to the RT profession in Canada: – the majority have completed education in a health profession other than respiratory therapy, often in medicine or anaesthesiology; – the majority have completed education in a country where English or French is not the primary language of clinical practice; – virtually all such applicants are required to complete additional theoretical and/or clinical education in Canada in order to meet the education requirement of registration.

9. Findings (cont’d) Challenges for regulators and internationally educated applicants reported a number of challenges in the registration process: – difficulty performing credential assessment of international education programs, particularly in comparing non-RT programs to the education requirements for RT registration; – the length of time and costs required to go through prior learning assessment (PLA) and/or additional education; – lack of educational programs and resources designed to meet the learning needs of these applicants and help them to “bridge” to meeting the requirements of RT registration.

10. Findings (cont’d) Positive findings: – Several collaborative initiatives on-going and in development between regulators and educational institutions to assist internationally educated applicants meet provincial registration requirements. – Applicants who had completed PLA and/or additional education in Canada and who are now registered RTs were satisfied with these processes, even if they were a bit challenging. – These RTs reported no difficulty finding employment and were very satisfied in the profession.

11. Learning from other Access Initiatives Themes Collaborative initiatives Providing information to newcomers Credential assessment and Prior Learning Assessment and Recognition Mentorship and preceptorship Bridging and other preparatory education

12. Recommendations Information for Applicants 1.Where not already available, develop plain language information regarding registration requirements specifically aimed at internationally educated applicants. Such information should be made available on each jurisdiction’s web site and on the new NARTRB web site. 2.Develop hard-copy and web resource lists of contact information (regulators, schools) and all available courses and programs available for IERTs/IEHPs across Canada. This information should be made available on request and posted and kept up to date on the NARTRB web site, and provincial regulators’ sites may link to it.

13. Recommendations Common Credential Assessment Process 3.Collaborate within NATRB to develop: a.Common credential assessment criteria; b.A common credential assessment model; and c.A shared a database of credentialing decisions that could be shared by regulated jurisdictions.

14. Recommendations Prior Learning Assessment 4.Collaborate within NATRB and with RT educators to: a.share experiences and practices in PLA and competency- based assessment; b.explore the replication of processes and resources for use in other provinces; and c.explore development of new common PLA processes such as the expanded use of simulation laboratories to assess skills and competencies.

15. Recommendations Bridging programs 5.Build upon the existing PLA process in Ontario and the education integration initiatives provided by Quebec CEGEPs to develop bridging program(s) for internationally educated IEHPs to “bridge” from their health education background to respiratory therapy. Such programs should ideally: – build upon the existing skills of IERTs/IEHPs; – include profession- or healthcare-specific language and communications; – include specific orientation to Canadian culture/heath-care practice; – include integrated clinical education; – be offered full-time, ideally for a year or less; – be structured program so that learners are eligible for student or other financial assistance; – allow learners to receive a certificate or diploma of completion;

16. Recommendations Professional Supports 6.Consider the development of peer support mechanisms such as opportunities for IERTs/ IEHPs going through the registration process to meet (in-person or as part of an on-line community) to exchange information, form informal study partnerships etc. 7.Develop a mentorship model (which would include defining roles, orientation, training support for mentors) to match practising registered RTs with IERT/IEHP applicants in order to provide guidance, support and professional inclusion. Where possible, it would be particularly pertinent to recruit IEHPs who have become successfully registered to take on the mentorship

17. Recommendations Communication to International Medical Graduates 8.Consider communicating to organizations that provide services to internationally educated physicians or anaesthetists, to make them aware of the potential to “bridge” to the respiratory therapy profession.

18. Actions to Date In 2008 the National Alliance of Respiratory Therapy Regulatory Bodies considered all of the recommendations and set the priorities for moving forward on this important initiative. These have included: 1.development of the NARTRB website 2.development of a Fact Sheet for IEHPs 3.Learning Days 4.NARTRB discussions regarding credentialing processes and potential development of a database of credentialing decisions Other actions may require longer-term planning and additional resources, such as other phases of HRSDC FCR funding, designed to assist which are made available to assist with the development and piloting of tools and resources and the implementation of programs.

19. For more information: Contact Andrea Nelson, Project Manager/Directrice du projet National Alliance on Respiratory Therapy Regulatory Bodies/ L'Alliance nationale des organismes de réglementation de la thérapie respiratoire Tel: (613)731-3164 or 1-800-267-3422, ext 31 E-mail: nartrb@csrt.comnartrb@csrt.com Check the NARTRB web site for updates.

20. - Thank you - Questions?