“Bringing the Global Perspective Home: Issues in Assessing and Testing International Pharmacists”

1. “Bringing the Global Perspective Home: Issues in Assessing and Testing International Pharmacists” Christyna Schillemore R. Ph., B.Sc.Phm., M.Ed. Manager, Registration Programs Ontario College of Pharmacists Presented at the 2005 CLEAR Annual Conference September 15-17 Phoenix, Arizona

2. Setting the Context 2001 to 2003 • Ontario received 57% of immigrants to Canada • Quebec 16% • British Columbia 15% Presented at the 2005 CLEAR Annual Conference September 15-17 Phoenix, Arizona

3. Setting the Context • In 2003 approx 120,000 immigrants to Ontario – 84% settle in GTA • 70% have post secondary education Presented at the 2005 CLEAR Annual Conference September 15-17 Phoenix, Arizona

4. Setting the Context • Ontario has the most diverse population in Canada - 27% are foreign born • 44% of Toronto residents are foreign born • Immigrants account for 50% of Canada’s population growth Presented at the 2005 CLEAR Annual Conference September 15-17 Phoenix, Arizona

5. Acronyms Presented at the 2005 CLEAR Annual Conference September 15-17 Phoenix, Arizona

6. Ontario College of Pharmacists • 10,000 Members • 25% are educated outside Canada • 25% are educated in other provinces and the U.S. • 50 % are educated at the University of Toronto Presented at the 2005 CLEAR Annual Conference September 15-17 Phoenix, Arizona

7. Requirements for Licensure as a Pharmacist in Ontario Presented at the 2005 CLEAR Annual Conference September 15-17 Phoenix, Arizona

8. Rationale for IPG Program • Trends – increase in number of internationally trained pharmacists • Adoption of a set of National Competencies for pharmacists • Changes in training requirements • Changes in the National Licensing Exam Presented at the 2005 CLEAR Annual Conference September 15-17 Phoenix, Arizona

9. Rationale for IPG Program cont’d • Feedback from focus groups of international pharmacists & preceptors • Results from Quality Assurance Practice Review • Different standards between Canadian Pharmacy programs and those outside North America Presented at the 2005 CLEAR Annual Conference September 15-17 Phoenix, Arizona

10. International Pharmacy Graduate (IPG) Program • OCP Grant to Faculty of Pharmacy, University of Toronto for 3 years • Developmental costs • Faculty to provide access to resources and existing courses • Goal: Similar competency outcomes for IPGs and U of T/Canadian students Presented at the 2005 CLEAR Annual Conference September 15-17 Phoenix, Arizona

11. IPG Program Expansion • $3 million in grants from MTCU • Partnership between the Government, University Faculty and OCP Presented at the 2005 CLEAR Annual Conference September 15-17 Phoenix, Arizona

12. IPG Program Overview • PRIOR LEARNING ASSESSMENT – to evaluate each individual’s specific learning needs and level of practice readiness • EDUCATION –customized learning from curricula packaged as 2 eight week academic modules • (CPS I & II) • MENTORSHIP – to enhance links to the pharmacist community and to facilitate professional enculturation and post-program employment • DISTANT TECHNOLOGIES – to reduce barriers to access & make program components available throughout the province Presented at the 2005 CLEAR Annual Conference September 15-17 Phoenix, Arizona

13. Lessons Learned from the IPG Program • Build on fluency with profession specific language and supports • Previous Canadian Workplace experience to provide context for learning • Enculturation to Canadian workplace is important Presented at the 2005 CLEAR Annual Conference September 15-17 Phoenix, Arizona

14. Lessons Learned from the IPG Program cont’d • Need close linkages to employers for training placements, financial supports & job opportunities • Communication pathways important • Sustainability of program • Accessibility of program (geographic & financial) • Marketing value of the program Presented at the 2005 CLEAR Annual Conference September 15-17 Phoenix, Arizona

15. Challenges in Assessment and Testing IPG Program International Candidates are treated as a homogeneous group but are not • Ethical perspectives and cultural contexts misperceptions • Formative feedback • Cultural competence vis a vis test taking • Self assessment • Role play Presented at the 2005 CLEAR Annual Conference September 15-17 Phoenix, Arizona

16. Challenges in Assessment and Testing cont’d National Licensing Exam (PEBC) • Limit on the number of attempts on the national licensing exam • Some candidates do not take the limit seriously until too late • Computer based testing not currently available- cost, security concerns • Testing not available outside Canada • Nature of OSCE does not allow widespread testing Presented at the 2005 CLEAR Annual Conference September 15-17 Phoenix, Arizona

17. Challenges in Licensing • IPG program is a mandatory but exemptible requirement • It appears on paper that circumventing the IPG program is cheaper, faster route to licensure • IPG program is not yet widely available across the province • University is not ready to guarantee the offering of IPG program without base funding Presented at the 2005 CLEAR Annual Conference September 15-17 Phoenix, Arizona

18. Culture “Culture is like water to a fish. A fish does not know water exists until it jumps out of it.” Presented at the 2005 CLEAR Annual Conference September 15-17 Phoenix, Arizona

19. Cultural Competence “…is defined as a set of congruent behaviours, attitudes, and policies that come together in a system, agency or among professionals and enables that system, agency or those professionals to work effectively in cross-cultural situations”. (Cross et al., 1989; Isaacs & Benjamin 1991.) Presented at the 2005 CLEAR Annual Conference September 15-17 Phoenix, Arizona

20. Cultural Competence • Language of practice • Social language- verbal/nonverbal • Understanding of Canadian healthcare system • Values and norms (e.g. ethics) • Workplace norms ( teamwork, management, performance, hierarchy) Presented at the 2005 CLEAR Annual Conference September 15-17 Phoenix, Arizona

21. Hidden Costs of Pharmacists Lacking Cultural Competence • Lack of confidence or ability to use professional judgment • Lack of communication skills and cultural competency can result in the escalation of dispensing errors • Impact of using inappropriate or overly technical language in counselling • Failure to thrive in the workplace Presented at the 2005 CLEAR Annual Conference September 15-17 Phoenix, Arizona

22. Websites of Interest • Regulators Consortium www.regulators4access.ca • OCP www.ocpinfo.com • IPG Program www.ipgcanada.ca • PEBC www.pebc.ca Presented at the 2005 CLEAR Annual Conference September 15-17 Phoenix, Arizona

23. Speaker Contact Information Christyna Schillemore Ontario College of Pharmacists 483 Huron Street, Toronto, Ontario Canada M4R 2R4 Phone: 416-962-4861 x242, Fax: 416-847-8265 cschillemore@ocpinfo.com www.ocpinfo.com Presented at the 2005 CLEAR Annual Conference September 15-17 Phoenix, Arizona