Moving Forward Integration of IPGs

July 21, 2017 | Author: Sanghyeon Shawn Lee | Category: Pharmacist, Pharmacy, Provinces And Territories Of Canada, Survey Methodology, Health Human Resources
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Integration of International Pharmacy Graduates into the Canadian Pharmacy Workforce: Barriers and Facilitators FINAL REPORT

January 2008 Prepared for: Moving Forward: Pharmacy Human Resources for the Future Prepared by: R.A. Malatest & Associates Ltd. and Ms. Marie Rocchi

Funded by the Government of Canada’s Foreign Credential Recognition Program

© 2008 Canadian Pharmacists Association

Integration of International Pharmacy Graduates into the Canadian Pharmacy Workforce: Barriers and Facilitators FINAL REPORT January 2008 Prepared for: Moving Forward: Pharmacy Human Resources for the Future Prepared by: R.A. Malatest & Associates Ltd. and Ms. Marie Rocchi

The Moving Forward initiative is funded by the Government of Canada's Foreign Credential Recognition Program. The opinions expressed in this publication are those of the author and do not necessarily reflect those of the Government of Canada.

How to cite this document: Management Committee, Moving Forward: Pharmacy Human Resources for the Future. Integration of International Pharmacy Graduates into the Canadian Pharmacy Workforce: Barriers and Facilitators. Ottawa (ON). Canadian Pharmacists Association; (2008)

Table of Contents Executive Summary........................................................................................................ Overview of Moving Forward: Pharmacy Human Resources for the Future ............1 Acknowledgements ......................................................................................................2 Acronyms Used in this Report .....................................................................................4 Introduction .................................................................................................................5 Background to the Project...............................................................................................5 Purpose and Scope of Study............................................................................................6 Overview of Report..........................................................................................................7 Section 1: Research Approach and Methodology ........................................................8 Research Design ..............................................................................................................8 Specific Research Components .......................................................................................8 Research Considerations ...............................................................................................12 Section 2: Findings.....................................................................................................13 Settling in Canada..........................................................................................................13 Profile of IPGs Settling in Canada.............................................................................13 Deciding to Settle in Canada ....................................................................................16 Expectations of IPGs in Settling in Canada ..............................................................16 Sources of Information .............................................................................................16 Information Lacking in the Country of Origin .........................................................17 Licensing and Registration ............................................................................................18 Information About the Licensure Process ................................................................19 Number of IPGs Seeking Licensure ..........................................................................19 Performance of IPGs in the PEBC National Pharmacy Examinations .......................20 Number of Attempts at PEBC Examinations.............................................................21 Challenges Faced by IPGs in the Licensing and Registration Process ......................22 Additional Programs or Services Needed to Support IPGs on the Path to Licensure ......................................................................................................24 Supports Being Offered by Employers .....................................................................26 Enablers of Success in the Licensing and Registration Process ................................26 Perceived Effectiveness of Licensing Process ............................................................27 Bridging Programs .........................................................................................................28 Current Bridging Programs Available for IPGs .........................................................28 Awareness and Usage of Bridging Programs.............................................................28 Reasons IPGs Do or Do Not Participate in a Bridging Program ...............................32 Perceived Effectiveness of Bridging Programs ..........................................................34 Perceived Gaps in Program Delivery.........................................................................35 Working in Canada ........................................................................................................36 Profile of Employment of IPGs .................................................................................36 Perceptions of Employers .........................................................................................39 Benefits of Hiring IPGs .............................................................................................43 Barriers or Challenges to IPG Success......................................................................44 Facilitators of IPG Success ........................................................................................46

Integration of International Pharmacy Graduates into the Canadian Pharmacy Workforce: Barriers and Facilitators

TABLE OF CONTENTS Section 3: Key Findings..............................................................................................49 Settling In Canada .........................................................................................................49 Licensing/Registering to Practise as a Pharmacist in Canada ........................................49 Bridging Programs.........................................................................................................50 Working in Canada ........................................................................................................51 Research Appendices..................................................................................................52 Appendix A: Bibliography .............................................................................................54 Appendix B: Survey Questionnaires .............................................................................56 Appendix C: Interview Guides ......................................................................................57 Appendix D: Focus Group Moderator Guides..............................................................58 Appendix E: Template for Bridging/Support Program Fact Sheets...............................59

© 2008 Canadian Pharmacists Association

Executive Summary

EXECUTIVE SUMMARY Introduction The study of issues surrounding the Integration of International Pharmacy Graduates into the Canadian Pharmacy Workforce was designed to describe barriers and facilitators surrounding the licensing and registration of international pharmacy graduates (IPGs) and their integration into Canadian pharmacy practice. The study was commissioned as part of Moving Forward: Pharmacy Human Resources for the Future. This initiative is a collaboration of eight national pharmacy stakeholders, including the Canadian Pharmacists Association, and is examining the factors contributing to pharmacy human resources challenges in Canada. The objectives of the research are to provide a profile of IPGs in Canada, an understanding of the information, supports, and programs that are available to IPGs, the challenges they face in becoming licensed to practice and integrated into the Canadian pharmacy workforce, and what further supports may be needed to help alleviate these challenges. For the purpose of this study, IPGs are defined as individuals living in Canada who completed their undergraduate pharmacy education in a country other than Canada or the United States of America. This research project collected data from many different sources in order to provide a comprehensive overview of IPG human resources issues. The research undertaken included the following: • A national survey of IPGs (n=1067); • A survey of pharmacy employers (owners, managers, and directors) (n=315); • In-person or telephone interviews with key informants from the provincial pharmacy regulatory authorities, provincial associations, and large pharmacy chains (n=27); • Interviews with providers of bridging programs and courses (n=10); • Four focus groups with IPGs; • Two focus groups with employers, and • A literature and statistical review.

Settling in Canada There is currently no comprehensive source of data on the number or proportion of IPGs in the Canadian pharmacy workforce. However, recent data from the Canadian Institute of Health Information report that the percentage of licensed practising pharmacists in Ontario and Alberta who are IPGs is 27% and 8%, respectively. According to information from Citizenship and Immigration Canada, approximately 500 new immigrants come to Canada each year stating that they intend to work as pharmacists. This figure includes only “economic class” immigrants and does not include other populations of newcomers to the country. IPGs most often arrive in Canada from Southeast Asia (30%) or the Middle East (26%). Common countries of origin include India, Egypt, Pakistan, the Philippines, Iran and Jordan. The majority of IPGs settle in Ontario. Most IPGs come to Canada with undergraduate degrees in pharmacy. In addition, 14% of surveyed IPGs indicated that they had completed a master’s degree, 8% had completed a

Integration of International Pharmacy Graduates into the Canadian Pharmacy Workforce: Barriers and Facilitators

Executive Summary

PharmD degree, and 3% had completed a PhD. It is not known if these graduate degrees were entry-to-practice requirements in the IPG’s country of orgin. The majority (85%) of IPGs have practised as pharmacists in their country of origin before settling in Canada. IPGs generally appear to be making their own decision to settle and work in Canada. IPGs consult a variety of different sources in making these decisions. Often, they rely on the Internet, accessing information through the websites of the Pharmacy Examining Board of Canada (PEBC) and provincial pharmacy regulatory authorities (PRAs), among others. Family and friends already in Canada are also important sources of information for IPGs. Decisions on where to settle in Canada are often being made based on where family and friends are already living in Canada. IPGs generally choose to initially settle in large cities, where they feel they and their family members can more easily integrate into Canadian society, and where they believe that they are more likely to find pharmacy jobs. Some IPGs are making decisions based on incomplete information or incorrect assumptions. For example, while many IPGs feel that they should settle in the largest cities where there are likely to be more job opportunities, many key informants stated that most opportunities for pharmacist jobs are located in smaller cities or towns. IPGs settling in Quebec are generally more proficient in French than English, and move to that province in order to be able to work and live in French. Over three-quarters (78%) of IPGs who settle in Canada expect to eventually work as pharmacists. Some IPGs have no particular expectations related to their own career, and move primarily for reasons related to family. Summary of Settling in Canada • While IPGs come from many different areas and backgrounds, they are typically from Southeast Asia or the Middle East, possess an undergraduate pharmacy degree as their highest level of education, and have experience working as a pharmacist. • Before settling in Canada, IPGs most often find information about becoming a pharmacist in Canada using the Internet, or through friends and family already living in Canada. • Most IPGs settling in Canada expect they will eventually work as pharmacists in Canada, and most have already practised as pharmacists in their previous career.

Licensing/Registering to Practise as a Pharmacist in Canada In order to practise as a pharmacist in a pharmacy, IPGs must become licensed (or registered) to practise by the pharmacy regulatory authority of their chosen province. The steps involved in this process, and their order, vary by province, with Quebec’s licensing process being significantly different than that of the other provinces. Generally, however, IPGs must submit their documents for evaluation to the Pharmacy Examining Board of Canada (PEBC) for verification of identity and comparability of university credentials, undertake an Evaluating Examination, complete a two-part Qualifying Examination (which includes a multiple choice exam and a simulated practice component called the Objective Structured Clinical Examination, or OSCE), demonstrate English (or French) language fluency, undertake an apprenticeship period (known as structured practical training), and pass a provincial examination concerning issues of jurisprudence. The first two steps (Document Evaluation and the Evaluating Exam) can be completed outside of Canada,

© 2008 Canadian Pharmacists Association

Executive Summary

whereas the other steps are usually completed within the country. The PEBC is responsible for the assessment of graduates in all provinces except Quebec. In Quebec, IPGs undergo a foreign credential recognition process through a provincial committee, which assesses their prior education and determines which courses they must complete at a Quebec university to achieve equivalency with Quebec pharmacy graduates. They must also demonstrate French language fluency and undertake structured practical training. IPGs are generally reliant on the Internet for their information about the various steps of the licensure process, although some IPGs receive assistance directly from the PEBC, the PRAs, or from employers and peers. During the time period of 2002-2006, an annual average of 876 unique, individual IPGs presented their documents for evaluation. During the same time period, an annual average of 694 unique IPGs attempted the Evaluating Examination; an average of 524 IPGs attempted the Qualifying Examination Part I (the multiple choice questionnaire) and an average of 433 IPGs attempted the Qualifying Examination Part II (the OSCE). Candidates can have up to four attempts to pass each examination. During the years 2002 to 2006, combining all examination sittings, the IPG pass rate was 59% for the Evaluating Examination, 48% for the Qualifying Examination Part I, and 45% for the Qualifying Examination Part II. While only a quarter (26%) of unique IPGs made multiple attempts at the Evaluating Examination, almost one-half of unique IPGs made multiple attempts at both parts of the Qualifying Examination during that period (46% and 48% respectively). By comparison, less than 10% of domestic graduates generally make more than one attempt at the Qualifying Examination. IPGs feel that the PEBC Qualifying Examination, particularly the OSCE, is the most difficult part of the licensing process. About three-quarters of surveyed IPGs feel that the Qualifying Examination Part I (74%) and Qualifying Examination Part II (77%) were “difficult” or “very difficult”, with 19% rating Qualifying Examination Part I and 28% rating Qualifying Examination Part II as “very difficult”, respectively. The Evaluating Examination was also rated as “difficult” or “very difficult” by a majority (58%) of IPGs. Finding a practical training position was rated as “very difficult” by 26% of IPGs, and “difficult” by 28% of IPGs. IPGs often find the licensure process to be time-consuming and costly. The average amount of time for the licensure process was 26 months, with 58% of IPGs who had been licensed in Canada indicating that the process had taken two years or more. In Quebec IPGs are required to attend courses at either of the province’s two university faculties of pharmacy. Consequently, there is a strong demand for these courses, and some IPGs report that the time required to achieve educational equivalency is often considerable. Costs accrued by IPGs as they undertake the necessary steps to achieve licensure may be considerably higher than those of Canadian graduates. They can include fees for evaluation processes, national examinations (often repeated), and bridging or support training. Both IPGs and employers feel there is a need for more bridging programs and courses to help IPGs through the licensure process. IPGs generally felt that more opportunities for practical/work experience were needed, whereas employers generally suggested that language/communication skills training were most critical. Integration of International Pharmacy Graduates into the Canadian Pharmacy Workforce: Barriers and Facilitators

Executive Summary

Summary of Licensing/Registering to Practice as a Pharmacist in Canada • The pass rates of IPGs on the Qualifying Examination are low compared to those of Canadian graduates. • A large percentage of IPGs make multiple attempts at the Evaluation and Qualifying Examinations. • IPGs often take two years or more to become licensed to practise as a pharmacist. • IPGs identified the Qualifying Examination Part II (the OSCE) as the most difficult step in the licensing process, but generally find all PEBC examinations to be difficult. • Both IPGs and employers feel that additional programs or supports are needed to support IPGs on the path to licensure. IPGs are most often looking for programs and supports that provide practical experience, whereas employers feel language/communication skills support are most critical.

Bridging Programs and Courses Across Canada, there are a number of bridging programs and courses available to help IPGs become licensed to practise as pharmacists in Canada. These programs help internationally trained pharmacists adapt to the various aspects of practice in the Canadian context. For the purposes of this study, bridging programs are defined as formal, post-degree programs of study designed to address gaps between an IPG’s education or experience and the standards of pharmacy practice in Canada. This research identifies and documents 9 such programs. These include programs for IPGs at the University of Toronto (U of T) and the University of British Columbia (UBC), as well as programs offered through private trainers in Ontario, Alberta, Manitoba, and Nova Scotia. Bridging programs are generally publicized through provincial pharmacy regulatory authorities, provincial pharmacy associations, the PEBC, employers, and immigrant settlement agencies. About one half of IPGs across Canada are aware of the programs, even though these programs are generally accessible only to those IPGs located in or around the selected cities where the courses are offered. No IPG bridging programs currently exist in the province of Quebec, although key informants reported a program was currently under development. While 60% of IPGs said they had never taken a bridging program and had no plans to register in one in the future, interviews with the representatives from the programs indicate that the number of students enrolled in these programs is on the rise, and will likely continue to grow in the future. Although geographic accessibility is one explanation, most IPGs who are not taking bridging programs (51%) stated they did not take the program because they simply did not feel a need to do so. Other reasons included not being aware of the programs (27%), or lacking the money required to take the program (17%). Many IPGs find the cost of the bridging programs, $10,000 or more for the most extensive courses, to be prohibitive. Those IPGs who do take bridging programs feel the programs are effective in a variety of ways. Most IPGs who had taken the programs stated that the programs were “effective” or “very effective” in providing information on pharmaceutical care (83%), applied therapeutics (80%), roles and responsibilities of pharmacists in Canada (79%), and on other topics. The programs also report considerable success rates among program completers in subsequently becoming licensed to practise.

© 2008 Canadian Pharmacists Association

Executive Summary

Summary of Bridging Programs and Courses • Nine bridging programs and courses specifically for IPGs from across Canada were identified and documented. These vary from intensive university-based programs to OSCE preparatory courses. • Bridging programs and courses are generally seen as beneficial to the IPGs who participate in them. • Not all IPGs have access to the existing bridging programs. The existing programs are not available in many areas of the country, and those that exist can be prohibitively expensive. • A large proportion of IPGs feel they do not need to take bridging programs.

Working in Canada The majority of IPGs (78%) expect that they will eventually work as pharmacists in Canada, and the majority have tried to work as either pharmacists (72%) or as pharmacy technicians (61%) since arriving in Canada. Despite the many challenges of settling in a new country and becoming licensed to practice as pharmacists, 70% of surveyed IPGs reported that they had worked as pharmacists in Canada at some point since settling in Canada. Almost half (46%) of IPGs also indicated that they had at some point worked as pharmacy technicians since settling in Canada. This is sometimes an interim step on the path to becoming a pharmacist, or as a second choice if they have not been able to realize their goal of working as a pharmacist in Canada. Others have chosen to work in the pharmaceutical industry where license/registration is not generally required. Further, 44% of pharmacy employers indicated that they had hired at least one IPG during the past three years. Employers generally offer employment to IPGs who are permanent residents (landed immigrants), or to those who have become Canadian citizens. Employers also typically offer employment most often to IPGs who have successfully completed the PEBC Evaluating Exam, or have been practising in Canada for up to five years. Over one-third of employers however indicated that they were not aware of the immigration status (25%) or the stage in the licensure process (12%) of IPGs they have hired. IPGs are finding employment in all types of pharmacies, including chain, banner, or franchise pharmacies (51% of IPGs who had been employed in Canada); independent community pharmacies (34%); health care facilities (12%); or other types of pharmacies (2%). While IPGs are often employed in larger cities, a significant proportion of IPGs find work in mid-size or smaller cities as well. Only 37% of IPGs who have worked as a pharmacist in Canada reported that their pharmacy was located in a city of more than 500,000 people, with the remainder being in smaller centres. Many IPGs are resettling within Canada to work as pharmacists: 31% of IPGs who had worked as pharmacists had to move from where they first settled in order to find employment as a pharmacist. While many IPGs who settle in smaller centres for work thrive in their new communities, some are more comfortable in larger centres, where they more often have the support of their cultural and/or religious communities.

Integration of International Pharmacy Graduates into the Canadian Pharmacy Workforce: Barriers and Facilitators

Executive Summary

Employers also do not generally appear to see particular benefits to hiring IPGs over domestic graduates. However, a somewhat higher proportion of employers agreed than disagreed (39% versus 17%) that IPGs are generally more experienced than new Canadian graduates. Employers do not generally agree that IPG employees provide access to new patients/clients (24% agreeing versus 27% disagreeing), and there appears to be limited awareness of the cultural benefits that IPGs can bring to pharmacies. Employers do not generally appear to feel that IPGs require more time to supervise or train than domestic graduates. While key informants felt that this can be a concern for employers, and particularly for preceptors, this was not evident in the employer survey results. Most employers who reported that they had not hired any IPGs stated that this was largely the result of not having had any recent open positions or any IPG applicants. Still, most employers felt that barriers to success for IPGs did exist, particularly related to language and communication skills. The top barriers to IPGs’ success identified by employers were lack of proficiency in communicating effectively with patients and clients (67% of employers stated it was a barrier for IPGs), lack of proficiency in spoken English or French (66%), lack of proficiency in written English or French (60%), and lack of proficiency in communicating effectively with other pharmacy staff and other health care providers (55%). The changing, and expanding, role of pharmacists in the Canadian health care system was also often cited as a challenge for IPGs. The current pharmaceutical care model in Canada requires a high level of patient consulting and advising, and many IPGs are typically not trained to practise according to this model. Summary of Working in Canada • Despite the challenges of licensure and settling in Canada, most IPGs appear to be finding work in pharmacy. • Many IPGs are finding work as pharmacy technicians in Canada, often either as an interim step in the process of becoming pharmacists, or because of difficulties becoming licensed or finding employment as pharmacists. • While IPGs face many challenges to success in the Canadian pharmacy workforce, communication skills are seen by employers as particularly severe barriers. • Differences in the culture of pharmacy practice are also perceived as significant challenges to IPG success. The role of pharmacists in Canada is often different than in other countries, leading IPGs to have to adapt to new professional roles and responsibilities. • Employers do not see particular advantages or disadvantages to hiring IPGs.

© 2008 Canadian Pharmacists Association

Overview of Moving Forward: Pharmacy Human Resources

Overview of Moving Forward: Pharmacy Human Resources for the Future One of the most urgent crises facing Canada’s health care system today is the appropriate management of health human resources. Pharmacists are a high-priority health human resource at many levels — involving patient care, drug supply management, health institutions, the health system and population health needs. Pharmacists have a key role to play at all these levels in ensuring pharmaceuticals are used appropriately, safely and provide optimal benefits. Serious challenges are facing the pharmacy sector’s efforts to optimize the management of its available human resources. These include the evolution of pharmacists’ and pharmacy technicians’ role in health care delivery, recruitment and retention difficulties and complexities in integrating international pharmacy graduates. A failure to address pharmacy human resource challenges will compromise the ability of the profession to respond to these new demands and its ability to fully address the safe and appropriate use of drugs in Canada. There is, therefore, an urgent need to understand the factors contributing to these human resources pressures and strategize potential solutions. A collaborative of eight national pharmacy stakeholders, including the Canadian Pharmacists Association (secretariat for the project), the Association of Deans of Pharmacy of Canada, the Association of Faculties of Pharmacy of Canada, the Canadian Association of Chain Drug Stores, the Canadian Association of Pharmacy Technicians, the Canadian Society of Hospital Pharmacists, the National Association of Pharmacy Regulatory Authorities and the Pharmacy Examining Board of Canada has partnered together to carry out Moving Forward: Pharmacy Human Resources for the Future. Funded by the Government of Canada’s Foreign Credential Recognition Program, Moving Forward is an in-depth examination of the factors contributing to pharmacy human resources challenges in Canada. It will offer recommendations to ensure a strong pharmacy workforce prepared to meet the current and future health care needs of Canadians. Through a series of investigations and consultations, Moving Forward will: • Develop a comprehensive understanding of the pharmacy workforce in Canada and the factors that influence its structure and the skills and competencies of its members; • Identify and analyze the short- and long-term human resource planning challenges facing the pharmacy sector, including those specific to IPGs, and • Offer recommendations for these challenges. The optimal management of pharmacy human resources requires more than just information; it requires planning. The recommendations developed by Moving Forward will be used by stakeholders at local, regional, provincial, territorial and national levels to develop their pharmacy human resources management plans. The findings contained in this report represent the results of Moving Forward’s research on the Integration of International Pharmacy Graduates into the Canadian Pharmacy Workforce: Barriers and Facilitators.

Integration of International Pharmacy Graduates into the Canadian Pharmacy Workforce: Barriers and Facilitators

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Acknowledgements

Acknowledgements The Moving Forward partners would like to express their appreciation to all the individuals whose participation in this research contributed to its success. Moving Forward wishes to especially thank the many people who kindly took the time to participate in surveys, focus groups, and interviews. This research study was conducted by R.A. Malatest & Associates Ltd. and Ms. Marie Rocchi. Invaluable assistance was provided by the Pharmacy Examining Board of Canada and the Ontario College of Pharmacists. The researchers were assisted by the Moving Forward Management Committee, National Advisory Committee, an IPG Working Group and numerous expert advisors. These contributors include:

Management Committee Kevin Hall (Moving Forward Co-Chair), Winnipeg Regional Health Authority Fred Martin (Moving Forward Co-Chair), West Prince Pharmacy Zubin Austin, Association of Faculties of Pharmacy of Canada Patty Brady, Human Resources and Social Development Canada Janet Cooper, Canadian Pharmacists Association Tim Fleming, Canadian Association of Pharmacy Technicians Dennis Gorecki, Association of Deans of Pharmacy of Canada Ray Joubert, National Association of Pharmacy Regulatory Authorities Paul Kuras, Canadian Pharmacists Association Allan Malek, Canadian Association of Chain Drug Stores Linda Suveges, The Pharmacy Examining Board of Canada Ken Wou, Canadian Society of Hospital Pharmacists

National Advisory Committee Sandra Aylward, Sobeys Pharmacy Group Danuta Bertram, Winnipeg Regional Health Authority Paul Blanchard, New Brunswick Pharmacists Association Anne Marie Burns, Ottawa Hospital Lynda Buske, Canadian Medical Association Jean-François Bussières, Hôpital Sainte Justine Nicolas Caprio, Shoppers Drug Mart Deborah Cohen, Canadian Institute for Health Information Omolayo Famuyide, Canadian Association of Pharmacy Students and Interns Rock Folkman, Canadian Pharmacy Technician Educators Association Anne Marie Ford, Ford’s Apothecary Michael Gaucher, Canadian Agency for Drugs and Technologies in Health Aline Johanns, New Brunswick Department of Health Nadine Lacasse, Sebastien Aubin et Nadine Lacasse Pharmaciens Manon Lambert, Ordre des pharmaciens du Québec Lisa Little, Canadian Nurses Association Jonathan Mailman, Canadian Association of Pharmacy Students and Interns Ron McKerrow, British Columbia Provincial Health Services Authority Colleen Norris, Glebe Pharmasave

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© 2008 Canadian Pharmacists Association

Acknowledgements

Acknowledgements Bonnie Palmer, Shoppers Drug Mart Noman Qureshi, International Pharmacy Graduate Alumni Association Michelle Rousel, New Brunswick Department of Health Chris Schillemore, Ontario College of Pharmacists Brenda Schuster, Regina Qu’Appelle Health Region Jane Wong, Canadian Healthcare Association

IPG Working Group and Advisors Josiah Akinde, International Pharmacy Graduate Mohja Alia, Metropolitan Immigrant Settlement Association Nicky Corkum, IWK Health Centre Catherine Ekeland, University of British Columbia Brian Hunjan, International Pharmacy Graduate Sandi Hutty, University of British Columbia Wendy Lack, Shoppers Drug Mart Ruth MacKenzie, Yukon Government Anik Minville, Ordre des pharmaciens du Québec Mustapha Olajuwon, International Pharmacy Graduate John Pugsley, The Pharmacy Examining Board of Canada Myrella Roy, Canadian Society of Hospital Pharmacists Shiva Justin Singh, International Pharmacy Graduate Julia Stanbridge, Bredin Institute Farzhad Valankani, International Pharmacy Graduate Cibele Walsh, International Pharmacy Graduate

Project Staff Heather Mohr, Project Manager Kelly Hogan, Research Coordinator

Integration of International Pharmacy Graduates into the Canadian Pharmacy Workforce: Barriers and Facilitators

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Acronyms Used in this Report

Acronyms Used in this Report ACPE CAP CIC CIIP CP3 CPhA CPS CSHP ELT IEHPI IELTS IPG MISA NAPRA OCP OSCE PEBC TOEFL UBC U of T

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Accreditation Council for Pharmacy Education Comité d’admission à la pratique Citizenship and Immigration Canada Canadian Immigration Integration Project Canadian Pharmacy Practice Programme Canadian Pharmacists Association Canadian Pharmacy Skills program Canadian Society of Hospital Pharmacists Enhanced Language Training Internationally Educated Health Professionals Initiative International English Language Testing System International Pharmacy Graduate Metropolitan Immigrant Settlement Association National Association of Pharmacy Regulatory Authorities Ontario College of Pharmacists Objective Structured Clinical Examination Pharmacy Examining Board of Canada Test of English as a Foreign Language University of British Columbia University of Toronto

© 2008 Canadian Pharmacists Association

Introduction

Introduction Background to the Project Pharmacists are a major component of the Canadian health care system, making up the third-largest segment of health care professionals in Canada.1 There are approximately 30,250 licensed pharmacists in Canada.2 Three-quarters (75%) of practising pharmacists work in community practice, 15% work in health care facilities (including hospitals and health clinics), and the remaining 10% work in universities, pharmaceutical companies, government departments, associations, and other organizations.3 While the Canadian faculties of pharmacy produce approximately 900 graduates each year,4 Canada’s pharmacist workforce draws heavily on individuals who were educated outside of Canada to meet pharmacy labour market demands. There is currently no comprehensive source of data on the number or proportion of internationally trained pharmacists in the Canadian pharmacy workforce. However, recent data from the Canadian Institute of Health Information report that the percentage of practising, licensed pharmacists who obtained their pharmacy education outside of Canada (or the United States of America) is 27% in Ontario and 8% in Alberta.5 While these statistics are not yet available for other provinces and territories, internationally trained pharmacists, commonly known as International Pharmacy Graduates (IPGs), represent a significant portion of the pharmacist workforce in Canada. For the purposes of this study, IPGs are defined as individuals who completed their undergraduate pharmacy education, or obtained their licence to practice, outside of Canada or the United States of America. IPGs often face many challenges in integrating successfully into Canadian pharmacy practice. Evidence suggests that these challenges include a lack of fluency in English or French, a lack of understanding of disease states or treatments that they may not have encountered in their country of origin, and general difficulties in communicating with patients and other members of the health care team in settings where professional and cultural norms may be different from what they are accustomed to. A lack of clinical applied knowledge and of practical experience have also been noted as important challenge.6 Research suggests that Canada is experiencing a strong demand for pharmacists. One estimate suggests that there are vacancies for approximately 2000 pharmacists across Canada, with approximately half of these vacancies in Ontario. While anecdotal reports suggest that the demand for pharmacists has decreased in recent years, many pharmacies,

1. Poston, J. International Pharmacy Graduates: Briefing to the Standing Committee on Citizenship and Immigration. Canadian Pharmacists Association, March 10, 2005. 2. National Association of Pharmacy Regulatory Authorities. National Statistics. Available from: http://www.napra.org/docs/0/86/363.asp. Accessed September 19, 2007. 3. Poston, J. International Pharmacy Graduates: Briefing to the Standing Committee on Citizenship and Immigration. Canadian Pharmacists Association, March 10, 2005. 4. Austin, Z, Rocchi Dean, M. Bridging education for foreign-trained professionals: the International Pharmacy Graduate (IPG) Program in Canada. Teaching in Higher Education. Jan 2006;11(1):19-32. 5. Canadian Institute for Health Information, Pharmacist Database, 2006 data. 6. Austin, Z, Rocchi Dean, M. Bridging education for foreign-trained professionals: the International Pharmacy Graduate (IPG) Program in Canada. Teaching in Higher Education. Jan 2006;11(1):19-32.

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Introduction

particularly in smaller cities and towns outside of the major urban areas, struggle to fill their vacant positions. Demand for pharmacists is strong for a number of reasons, including the high numbers of retiring pharmacists and the expansion of chain drug stores offering extended hours of service.7 Furthermore, the demand for pharmacists is likely to remain strong in the future: the aging of he baby boomer generation, the introduction of new drug therapies, and the overall increased demand for health services are all likely to heighten the need for pharmacists. This demand for pharmacists mirrors a nationwide shortage of health care workers. Shortages in health human resources are so prevalent that the federal government has initiated a Pan-Canadian Health Human Resources Strategy aimed at increasing the recruitment and retention of health professionals. An integral part of this strategy is the Internationally Educated Health Professionals Initiative (IEHPI), designed to reduce the barriers to practice for internationally educated health professionals to enable them to successfully integrate into the Canadian health workforce. As Canadian health care evolves to support new roles and responsibilities for pharmacists, ensuring that IPGs are fully prepared for a career of pharmacy practice in Canada becomes more critical.

Purpose and Scope of Study Anecdotal evidence has long suggested IPGs face challenges to successful integration in the Canadian pharmacy workforce. The results and findings of this study provide a body of work that will identify and describe the challenges faced by IPGs, and offer information that can be used to address these challenges. Specifically, the research is intended to provides: • A comprehensive picture of IPGs in Canada, including their demographic profile, countries of origin, and their employment status and goals; • An understanding of the information, supports, and programs that are available to IPGs, and the perceived effectiveness of these resources; • An understanding of the challenges facing IPGs in obtaining their license to practice, and practising, as pharmacists, and • An understanding of what additional supports could help IPGs to successfully integrate into pharmacy practice. This project resulted in three major deliverables: • This integrated research report, detailing the findings and conclusions from all research activities; • A detailed inventory of the bridging programs and courses available to IPGs, and • A Road Map, detailing the steps IPGs take in the process of becoming licensed to practice as pharmacists in Canada, and the resources available at each step.

7. Austin, Z, Rocchi Dean, M. Bridging education for foreign-trained professionals: the International Pharmacy Graduate (IPG) Program in Canada. Teaching in Higher Education. Jan 2006;11(1):19-32.

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© 2008 Canadian Pharmacists Association

Introduction

Overview of Report This report outlines the detailed results and key findings based on the available research. Following a short overview of the research approach and methodology, the report is structured to follow the major stages in the process of integrating into the Canadian pharmacy workforce. The first section of findings, Settling in Canada, provides a profile of IPGs settling in Canada, details the expectations of IPGs in coming to Canada, and discusses what sources of information they use when deciding to come to Canada. Licensing and Registration presents findings related to the process of IPGs becoming licensed or registered to practice as pharmacists in Canada. The third section, Bridging Programs, summarizes the programs available for IPGs, discusses their perceived effectiveness, and looks at gaps in supports for IPGs. Finally, Working in Canada provides findings on the extent to which IPGs are finding employment in Canada, on employer perceptions of working with IPGs, and on what is helping or hindering the successful integration of IPGs into pharmacy practice. The report then presents a summary of Key Findings based on the research. The report also includes, as Appendices, a bibliography as well as data collection instruments for the project.

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Section 1: Research Approach and Methodology

Section 1: Research Approach and Methodology Research Design The Integration of International Pharmacy Graduates into the Canadian Pharmacy Workforce: Barriers and Facilitators is a comprehensive study involving multiple research components. The study examines the issues facing IPGs from a variety of sources, and includes both primary and secondary data. The information in this report represents a synthesis of information obtained through mixed-mode surveys of IPGs and pharmacy employers, interviews with key stakeholders, focus groups with IPGs and employers, as well as a literature and statistical review. Where possible, triangulation of sources is used to demonstrate the extent to which findings are consistent or different across data sources.

Specific Research Components Surveys Survey of International Pharmacy Graduates Surveys were undertaken with IPGs from across Canada in order to gather data on their experiences since deciding to settle in Canada, and their perspectives on Canadian pharmacy workforce integration. A total of 1067 IPGs completed survey questionnaires for the study.

Figure 1—1 IPG Survey Respondents by Province Province

Number

% of Total Surveys

Ontario

887

83%

Alberta

64

6%

British Columbia

45

4%

Quebec

43

4%

Manitoba

12

1%

Saskatchewan

6

1%

Nova Scotia

5

1%

New Brunswick

4

0.4%

Newfoundland and Labrador

1

0.1%

Prince Edward Island

0

0%

Territories

0

0%

1,067

100%

Total

IPGs were contacted about the survey using a variety of methods. Over 2100 postage-paid postcards and survey information letters were mailed from the Pharmacy Examining Board of Canada (PEBC) to international pharmacy graduates currently active within the PEBC

8

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Section 1: Research Approach and Methodology

certification process. IPGs interested in participating in the survey were asked to provide their name and contact information on the postcard provided and place it in the mail. These postcards were returned to the consultant, and IPGs who had responded were contacted by telephone to participate in the study. The study was also publicized by the Canadian Pharmacists Association (CPhA), the Canadian Society of Hospital Pharmacists (CSHP), the Canadian Association of Chain Drug Stores (CACDS), and the provincial pharmacy regulatory authorities using email notices, posting of information about the survey on their websites, and advertisements in newsletters. As a result, many IPGs contacted the consultant directly in order to participate in the surveys and focus groups. Finally, the Ontario College of Pharmacists (OCP) provided the consultant with contact names of approximately 2700 provincially licensed IPGs in Ontario. The survey questionnaire was available in English and French versions, and the questionnaire underwent a plain language review prior to distribution. All IPGs interested in participating in the study were given multiple methods of completing the survey questionnaire. IPGs had the option of completing the survey by mail, fax, online, or over the telephone. In all 1067 surveys were completed. Employer Survey Surveys were undertaken with pharmacy managers/owners, directors, and human resources managers from across Canada. The survey addressed the extent to which pharmacies have employed IPGs, and their perspectives on what challenges IPGs face.

Figure 1—2 Employer Survey Respondents by Province Province

Number

% of Total Surveys

Ontario

106

34%

Alberta

44

14%

British Columbia

31

10%

Quebec

47

15%

Manitoba

18

6%

Saskatchewan

15

5%

Nova Scotia

12

4%

New Brunswick

12

4%

Newfoundland and Labrador

13

4%

Prince Edward Island

10

3%

7

2%

315

100%

Territories Total

Integration of International Pharmacy Graduates into the Canadian Pharmacy Workforce: Barriers and Facilitators

9

Section 1: Research Approach and Methodology

In May 2007, 1014 survey packages containing a cover letter, frequently asked questions, and a copy of the survey were mailed out to a sample of pharmacy employers across Canada. The names and addresses of these employers were obtained from a mailing list provided by Dendrite. Dendrite, (formerly Synavant), has compiled a list of all pharmacists in Canada practicing in hospital or retail. This list was cross-referenced against a database obtained from CSHP and, where there were differences, the contact names and addresses of the CSHP database were used. As a result of the relatively low number of Quebec hospital pharmacies in the Dendrite sample, additional hospital pharmacy directors from Quebec were added, using the list provided by CSHP. As with the survey of IPGs, respondents had the option of completing the survey in French or English, and by mail, fax, online, or by telephone, and the surveys were publicized through CPhA, CSHP, CACDS and the provincial pharmacy regulatory authorities. A total of 315 surveys were completed by employers. Among those respondents, 51% were employed in chain, banner or franchise drug stores, 29% in independent pharmacies, 19% in health care facilities, and 1% in other types of organizations.

Figure 1—3 Percentages of Employer Survey Respondents by Type of Pharmacy 1% other 29% Independent pharmacy

19% Health care facility

51% Chain, banner or franchise drug store Source: Employment survey Q9 n=315 Source: Employer Survey Q9 n=315

Based on the overall population of 8053 pharmacies reported by the National Association of Pharmacy Regulatory Authorities (NAPRA), the survey has a margin of error of ±5.4%, 19 times out of 20. Qualitative Research Components Key Informant Interviews Semi-structured key informant interviews were undertaken with a wide range of stakeholders involved in pharmacy across Canada. A total of 37 in-person and telephone key informant interviews were conducted, with representatives from 10 bridging programs

10

© 2008 Canadian Pharmacists Association

Section 1: Research Approach and Methodology

and courses, and with 27 representatives from provincial pharmacy regulatory authorities, national and provincial pharmacy associations, large pharmacy chains, and settlement and support agencies. Questionnaires for these key informant interviews were developed by the consultant, were reviewed by the working group, and contained both quantitative (close-ended) and qualitative (open-ended) questions looking at a variety of topics, including licensing, bridging programs and courses, and working in Canada. Following the completion of interviews with the providers of bridging programs and courses, nine fact sheets were developed that detailed bridging programs and courses, currently offered in Canada for IPGs.8 These fact sheets represent a current inventory of bridging programs and courses available to IPGs in Canada. To ensure accuracy, these fact sheets were verified by the program/service managers. Focus groups Once preliminary analysis of the surveys and interviews had been conducted, six focus groups were held with employers (two groups), and with IPGs (four groups), to further explore the research issues. Focus groups were conducted in Toronto, Montreal and Edmonton. Participants were recruited from among those survey respondents who indicated an interest in taking part in a focus group. To supplement this group, additional pharmacies in Toronto and Edmonton were contacted to identify and invite further employer or IPG participants. Potential focus group participants were also identified through the project’s IPG Working Group and the project team’s Expert Advisor Marie Rocchi. The Consultant recruited a mixture of participants for the focus groups. Eligible IPG participants included individuals who had completed their undergraduate pharmacy education outside of Canada and who were working as pharmacists in Canada, currently pursuing licensure in Canada, or were no longer pursuing their licence. Eligible employers included managers and owners who had hired and/or who currently employed an IPG, as well as those who had not. Literature and Statistical Review Reports and academic literature of relevance to the study were reviewed to obtain an understanding of the issues surrounding the integration of IPGs into the Canadian pharmacy workforce and in order to inform the development of survey instruments for this study. A listing of the articles/publications reviewed as part of this study is provided in Appendix A. In addition, the Consultant reviewed statistical data of relevance to the study. For example, data was obtained from Citizenship and Immigration Canada (CIC) on the number of individuals coming to Canada as permanent residents declaring their intention to work as pharmacists. The Consultant also obtained detailed statistics from PEBC’s exam management system database on both the number of unique IPGs and domestic graduates attempting and successfully completing the PEBC Document Evaluation and Evaluating and Qualifying

8. Although the Consultant conducted 10 interviews with bridging and support program providers, nine fact sheets were prepared for programs specifically relevant to IPGs.

Integration of International Pharmacy Graduates into the Canadian Pharmacy Workforce: Barriers and Facilitators

11

Section 1: Research Approach and Methodology

Examinations for the years 2002 to 2006. These statistics were obtained based on the final attempt recorded by the PEBC of any IPG for each certification step; therefore each attempt represents one unique individual. However, as statistics were not captured beyond 2006, it is expected that a certain number of IPGs who were unsuccessful at their exam attempts may have gone on to make further attempts beyond the end of the data tracking period. This is especially true of those IPGs making their recorded attempts in the later years of the studied time period. The number of IPGs who have indeed gone on to make later attempts is not known. In addition to statistics on individual IPG candidates, the PEBC also provided statistics illustrating the “pass rates” of IPGs for each examination sitting. According to the PEBC, pass rate is calculated per exam sitting by dividing the total number of exams written per sitting by the number of exams which were successfully passed. These statistics do not distinguish between individual IPGs over sittings, and care must be taken when using these statistics to illustrate performance by pass rates over multiple years.

Research Considerations The Integration of International Pharmacy Graduates into the Canadian Pharmacy Workforce: Barriers and Facilitators used a variety of data sources and types of information in order to assure that its findings were based on defensible and comprehensive information. However, some limitations of the research should be noted. A large proportion of IPGs were identified through the PEBC and the provincial pharmacy regulatory authorities. As a result, most IPGs surveyed for the project had either attempted to obtain certification for licensure through the PEBC or were licensed to practise as a pharmacist. While some IPGs were informed through word of mouth and through referrals from settlement services and other venues, those IPGs in Canada who have not attempted to become licensed as pharmacists are likely under-represented in the survey responses. The extent to which the survey respondents are representative of all IPGs in Canada is not known. While the surveys were publicized across Canada through the national and provincial pharmacy associations and the provincial pharmacy regulatory authorities, the ability to undertake a direct mail-out of the surveys to IPGs licensed through OCP and the inability to do so in other provinces has likely resulted in IPGs in Ontario being over-represented among survey respondents. Further, those IPGs in Quebec, where pharmacists are not required to be certified to practice through the PEBC, are likely somewhat underrepresented. Only a small number (1%) of American-educated IPGs responded to this survey. This percentage should not be seen as necessarily representative of the number of Americaneducated pharmacists in Canada. While the definition of IPG used for this study was inclusive of American-educated pharmacy graduates, the study was not marketed to this group. Similarly, IPGs from the United States are exempt from the Evaluating Exam and, as such, they are not included in the PEBC statistics on these examinations displayed in the report. Finally, findings from the six focus groups represent the views of a limited number of IPGs and employers. While illuminating, the views of focus group participants should not be seen as necessarily representative of all IPGs and employers. 12

© 2008 Canadian Pharmacists Association

Section 2: Findings

Section 2: Findings Settling in Canada Profile of IPGs Settling in Canada In 2006, 426 permanent resident immigrants came to Canada with the declared intention of working as a pharmacist.9 This figure includes only those immigrants coming to Canada under the economic class and excludes those coming under family class (including being sponsored by a family member) who are not required by CIC to declare their intended occupation.10 This number also does not include temporary workers or those economic class immigrants intending to work as pharmacy technicians or assistants. The majority (60%) of these individuals were destined for Ontario, with British Columbia (15%) and Quebec (14%) being the next two most common provinces of destination in 2006. Over the period 1996 to 2006, British Columbia, Quebec and Alberta alternate as the second and third most popular destination provinces. The number of permanent resident immigrants with the intention to work as pharmacists showed overall growth in the years from 1996 to 2006.

Figure 2—1 Number and Province/Territory of Immigrants to Canada — Permanent Residents, Economic Class, with Intention to Work As Pharmacists in Canada (1996-2006) Province/Territory of Destination

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Newfoundland and Labrador















0

0





Prince Edward Island Nova Scotia New Brunswick

0 5 0

0 9 0

0 — —

0 — 0

0 — —

0 — —

0 — —

— — 0

0 — 0

0 — —

— — —

19

16

17

14

16

21

41

66

77

67

58

220 6 —

260 9 —

197 5 —

204 6 —

314 10 —

340 5 0

421 6 —

313 8 0

310 — 0

364 10 —

257 — —

14 47 —

14 52 0

21 41 0

15 38 0

16 43 0

17 60 0

22 52 0

14 45 0

33 56 0

31 68 —

36 63 0

0

0

0

0

0

0

0

0

0

0

0

316

364

291

281

405

452

548

451

489

534

426

Quebec Ontario Manitoba Saskatchewan Alberta British Columbia Yukon Province or territory not stated Total

Source: Citizenship and Immigration Canada, Facts & Figures 2006. Note: Due to privacy considerations, some cells have been suppressed and replaced with the notation "—". As a result, components may not sum to the total indicated. In general, suppressed cells contain less than five cases.

9. This number represents those indicating to CIC that they intended to work as pharmacists after immigrating; the extent to which this reflects their actual goals is not known. 10. According to CIC, 55% of immigrants to Canada fall under economic class status, compared to 28% under family class. The remainder (17%) includes refugees or others.

Integration of International Pharmacy Graduates into the Canadian Pharmacy Workforce: Barriers and Facilitators

13

Section 2: Findings

According to the survey of IPGs undertaken for this study, IPGs immigrating to Canada commonly received their undergraduate pharmacy education in Southeast Asia (30%) or the Middle East (26%). Other common areas of education were Europe (excluding the United Kingdom) (12%), Africa (11%), and the United Kingdom (11%).

Figure 2—2 Areas of the World Where IPGs Completed their Undergraduate Pharmacy Education Area

%

Southeast Asia (e.g., the Philippines, India, Pakistan, Bangladesh)

30%

Middle East (e.g., Egypt, Israel, Iran)

26%

Europe (Not including the UK)

12%

Africa

11%

United Kingdom

11%

Other Asia (e.g., Japan, Korea)

3%

China

2%

Russia and Commonwealth of Independent States United States of America

11

2% 1%

Australia

1%

Caribbean (e.g., Trinidad and Tobago, Jamaica, West Indies)

1%

South America

1%

n=1,067 Source: IPG Survey Q2 As a result of multiple responses, totals may add up to more than 100%

While most IPGs come to Canada with undergraduate degrees, a significant proportion of IPGs also have postgraduate pharmacy degrees. 14% of surveyed IPGs indicated that they had completed a master’s degree, 8% had completed a PharmD degree, and 3% had completed a PhD. It is not known if these reported graduate degrees were entry-to-practice requirements in the IPG’s country of origin. Generally, IPGs appear to have experience working as pharmacists in their countries of origin. The majority (85%) of surveyed IPGs indicated that they had practised as pharmacists before settling in Canada. About one-half (49%) of IPGs had primarily practised as pharmacists in community pharmacies, while 18% had practised in the pharmaceutical industry, and 16% had practised in a hospital. Eleven per cent of IPGs had experience in more than one area of practise before coming to Canada. The remainder indicated that they had primarily practised in government, academic institutions, the military, or in fields of practice.

11. Although a small portion of American graduates responded to the IPG survey, they were not part of the target sample. This percentage is not intended to reflect the percentage of American pharmacy graduates in the Canadian pharmacy workforce.

14

© 2008 Canadian Pharmacists Association

Section 2: Findings

Figure 2—3 Primary Area of Practice of IPGs Before Settling in Canada Primary Area of Practice

%

Community

49%

Pharmaceutical industry

18%

Hospital

16%

Multiple areas of practice

11%

Government

3%

Academic institution

3%

Military

1%

Other

1%

n=902 Source: IPG Survey Q4b.

The PEBC Evaluating Examination is a necessary step in the process of licensure for all provinces except Quebec, and the available statistics on its candidates provide a profile of many IPGs in Canada. In 2006, one-half (50%) of IPG PEBC Evaluating Exam candidates were 31 to 40 years of age. Those 20 to 30 years of age were the second most common group (26%), followed by those 41 to 50 years of age (20%).

Figure 2—4 IPG Evaluating Exam Candidates by Age (2006) 4% 20-30

20% 26%

31-40 41-50 51-60

50%

Source: PEBC Exam Management System Database

IPGs attempting the Evaluating Exam were almost evenly split between men and women, with 52% of candidates being female and 48% being male.

Integration of International Pharmacy Graduates into the Canadian Pharmacy Workforce: Barriers and Facilitators

15

Section 2: Findings

Deciding to Settle in Canada Decisions on where to initially settle in Canada are being made by IPGs based on a number of factors. IPGs in the focus groups in Toronto and Edmonton stated that decisions were based on where family and friends were located, and on their perception of where job opportunities may be. In many cases, the fact that friends and family from their countries of origin were already residing in a particular city was felt to make integration into that community easier. In other cases, IPGs settled in communities where they already had opportunities to work, or where their spouses had found a job. For the majority of the focus group participants in Montreal, fluency in the French language was the major deciding factor in their decision to settle in the province of Quebec. As francophones, they felt it was logical to settle in Montreal. As one IPG stated, “On se réalise mieux dans un endroit où on peut communiquer aver les gens” [you can better reach your potential in a place where you can communicate with others]. Not only did IPGs in Montreal feel that their ability to communicate in French would help their own personal and professional integration, but that it would ease the integration of their spouses and children. Many IPGs felt that settling in a large city was a natural choice. One IPG stated that they felt that bigger cities would have more employment opportunities for them. Another stated that, as a member of an ethnic community, it is easier to find acceptance in a big city. Expectations of IPGs in Settling in Canada Over three-quarters (78%) of IPG survey respondents indicated that, when they first settled in Canada, they expected that they would, at some point, work as a pharmacist. The majority of IPGs in the focus groups in Edmonton and Toronto had planned to work as pharmacists, or, as a second-best option, as pharmacy technicians. A few participants had no specific expectations related to their own employment, as they were moving as a result of their spouse’s employment opportunities or plans. IPGs in the focus group in Montreal had somewhat different expectations than those in the focus groups in Ontario and Alberta; they generally did not expect to work as pharmacists immediately after settling in Canada. Many had been told that they would have to return to university in order to obtain equivalency with Quebec pharmacists. Sources of Information IPG respondents consult a variety of sources of information to help them make their decision to practice as a licensed/registered pharmacist in Canada. IPGs most commonly consult the PEBC (73%), friends or peers living in Canada (67%), provincial pharmacy regulatory authorities (55%), or family living in Canada (48%). The three most common sources of information that IPGs found effective or very effective were the PEBC (44%), friends or peer living in Canada (43%), and the provincial pharmacy regulatory authority (30%).12 Of those IPGs who indicated another type of information consulted, most stated they consulted the Internet (no particular site specified) or Canadian universities. IPGs in the focus groups identified the Internet as the most frequently used, and most useful, source of information for the purposes of deciding to settle in Canada. Like the IPG survey respondents, IPG focus group participants got information through the PEBC website, which was said to be useful. Others noted that they had also found useful information through the provincial pharmacy regulatory authorities’ websites.

12. Percentages were calculated excluding “Don’t know” responses.

16

© 2008 Canadian Pharmacists Association

Section 2: Findings

Figure 2—5 Usage and Effectiveness of Available Sources of Information in Helping IPGs Make their Decision to Practice as a Licensed/Registered Pharmacist in Canada Effectiveness of Source (according to IPGs) % IPGs Who Consulted

Not Very Effective / Somewhat Effective

Effective / Very Effective

Don’t Know

Pharmacy Examining Board of Canada (PEBC)

73%

32%

60%

8%

Friends or peers living in Canada

67%

28%

64%

9%

Provincial pharmacy regulatory authority

55%

32%

54%

54%

Family living in Canada

48%

31%

48%

20%

Pharmacy employer

41%

36%

43%

21%

Friends or peers living outside of Canada

41%

52%

30%

19%

Canadian embassy or consulate

39%

56%

26%

17%

Federal government of Canada

37%

52%

25%

23%

Family living outside of Canada

34%

43%

31%

26%

Pharmacy recruiter

31%

37%

30%

32%

Canadian Pharmacists Association (CPhA)

28%

44%

24%

32%

Provincial government of Canada

26%

50%

19%

31%

Other (e.g., Internet, Canadian Universities)

97%

3%

9%

88%

n=1067 Source: IPG Survey Q6.

Information Lacking in the Country of Origin Many IPGs feel they did not have all the information they would have liked before settling in Canada. IPGs in the focus groups noted several information gaps, including the following: • A comprehensive, step-by-step overview of the process of becoming a pharmacist in Canada, including what can be done to begin this process prior to coming to Canada. Some IPGs noted that they were not clear what documentation from their country of origin would be needed in Canada, and that this caused difficulties or delays later in obtaining university transcripts and other documents. • Methods of connecting with other IPGs (such as through an online chat room or other web-based forum). This was felt to be critical in order to create realistic expectations of the licensing process. • More information pertaining to the costs involved in licensure, the actual length of time required to become licensed, the degree of difficulty of the process, and details on particular requirements in different provinces.

Integration of International Pharmacy Graduates into the Canadian Pharmacy Workforce: Barriers and Facilitators

17

Section 2: Findings

One key informant noted that the federal government has recently supported the provision of more comprehensive information at the country of origin through the Canadian Immigration Integration Project (CIIP). This federal program, managed through the Association of Canadian Community Colleges, has provided workshops and one-on-one counselling sessions in countries of origin for those coming to Canada through the federal Skilled Worker Program to help to create realistic expectations of the process of personal and professional integration in Canada. According to the project’s website, the CIIP is operated in sites in Guangzhou, China; New Delhi, India; and Manila, the Philippines.13

Licensing and Registration In order to practise as a pharmacist, IPGs must become licensed (or registered, as the process is known in some provinces) to practise by the pharmacy regulatory body of their province.14 In all provinces except Quebec, the process of licensure for IPGs involves the following activities (the order of which can vary by province): • Successful completion of the PEBC Document Evaluation process, which verifies that the applicant has acquired a legitimate university degree from a program that is acceptable to PEBC, and includes a verification of the identity of the applicant; • Successful completion of the PEBC Evaluating Examination, which demonstrates comparability of academic preparation in pharmacy; • Demonstration of sufficient levels of English or French language fluency as defined by standardized tests such as the Test of English as a Foreign Language (TOEFL) or others; • Successful completion of an in-service apprenticeship period, known as structured practical training, under the supervision of a qualified pharmacist; • Successful completion of the PEBC Qualifying Examination Part I, which involves a written test of clinical knowledge; • Successful completion of the PEBC Qualifying Examination Part II, the Objective Structured Clinical Examination (OSCE). The OSCE (introduced in 2001) involves candidates undertaking 16 seven-minute simulated patient interviews, or non-interactive stations, in order to test communication skills, clinical judgement and problem solving and ethical decision making, and • Successful completion of a provincial examination related to pharmacy jurisprudence. Domestic pharmacy graduates are also required to complete a structured practical training period, the PEBC Qualifying Examination Parts I and II, and a provincial jurisprudence examination. Graduates of American pharmacy programs are exempted from undergoing the PEBC Evaluating Examination. The PEBC is the certification body for the pharmacy profession in all provinces except Quebec, and is responsible for the assessment of graduates on behalf of participating provincial pharmacy regulatory authorities. Candidates (both IPGs and domestic graduates) can make three attempts at the PEBC examinations, and the Board will consider a request to attempt examinations a fourth time if the candidates are able to present acceptable evidence of continuing education units, course work (for the Qualifying Exam Part I) or practical experience in pharmacy (for the Qualifying Exam 13. Canadian Immigration Integration Project. Available from: http://ciip.accc.ca/default.aspx?DN=782,32,Documents. Accessed September 29, 2007. 14. In the territories, pharmacy practice is regulated through the cooperation of provincial regulatory bodies.

18

© 2008 Canadian Pharmacists Association

Section 2: Findings

Part II). If candidates are unsuccessful in their fourth attempt, the PEBC Board does not permit any additional attempts and the candidate cannot proceed further in the PEBC certification process. The licensing process for IPGs15 in Quebec is significantly different than in other provinces. In Quebec, academic qualifications are assessed on a case-by-case basis by a practice admissions committee (Comité d’admission à la pratique [CAP]) of the Ordre des pharmaciens du Québec. On the basis of the CAP assessment, IPGs are required to complete university pharmacy courses in Quebec at one of the province’s two university pharmacy faculties, University of Montreal or Laval University in order to be considered equivalent in their education to Quebec pharmacy graduates. The licensure process requires the successful completion of these courses as well as demonstration of French language fluency and the completion of the required number of structured practical training (600 hours). The pharmacy regulatory authority in Ontario also requires the completion of an IPG bridging program (available through U of T) as a requirement for licensure. It is currently the only province to include this requirement in addition to PEBC certification. This will be discussed in greater detail in the section discussing pharmacy bridging programs for IPGs. Information About the Licensure Process IPGs generally become informed about the various steps in the licensure process through the Internet and/or through the PEBC. Additionally, some areas of the country have developed specific resources to help IPGs to understand and manoeuvre through the licensing and registration process. For example, the Ontario College of Pharmacists (OCP) and the province of Ontario host a website designed for new pharmacists (www.newontariopharmacist.com). The site provides relevant information on the licensing process in that province, including a fact sheet and frequently asked questions section. In Nova Scotia, the Metropolitan Immigrant Settlement Association (MISA) produces a “welcome package” for new IPGs that provides step-by-step information on the licensing process in that province. Number of IPGs Seeking Licensure In 2006, 801 IPGs (excluding US graduates) successfully completed the PEBC Document Evaluation, the first step in the licensing process in all provinces except Quebec.16 As seen in Figure 2-6, among those IPGs successful in their Document Evaluation, most were from Southeast Asia (43%) (most commonly India, the Philippines, Pakistan), or the Middle East (30%) (most commonly Egypt, Iran, Jordan). The number of IPGs undertaking each of the steps of the PEBC certification from 2002 to 2006 is shown in Figure 2-7. Variations in annual totals of individuals attempting exams is likely due to several factors, including difficulties on the part of IPGs in immigration procedures, immigration fluctuations due to external factors, or IPGs choosing careers not requiring a pharmacy license. In particular, it should be noted that the Qualifying Examination Part II did not exist prior to 2001, thus affecting the number of individuals attempting this exam for the first time.

15. Including those trained in the United States of America 16. The number of candidates who are not successful in their Document Evaluation is not recorded by PEBC, but PEBC reports that this number is small.

Integration of International Pharmacy Graduates into the Canadian Pharmacy Workforce: Barriers and Facilitators

19

Section 2: Findings

Figure 2—6 Countries of Origin of IPGs Successfully Completing PEBC Document Evaluation (2006) Area

#

%

Southeast Asia (e.g., the Phillippines, India, Pakistan, Bangladesh)

348

43.4%

Middle East (e.g., Egypt, Israel, Iran)

244

30.5%

Europe (Not including the UK)

27

3.3%

Africa

70

8.7%

United Kingdom

21

2.6%

Other Asia (e.g., Japan, Korea etc.)

27

3.4%

China/Taiwan

22

2.7%

Commonwealth of Independent States

20

2.5%

Australia/New Zealand

3

0.4%

Caribbean/Central America

11

1.4%

South America

8

1.0%

801

100%

Total

An annual average of the number of unique IPGs attempting each step during the time period studied is also provided. Annually, an average of 876 unique IPGs submit documents for Evaluation, 694 unique IPGs attempt the Evaluating Examination, 524 unique IPGs attempt the Qualifying Examination Part I and 433 attempt the Qualifying Examination Part II.

Source: Pharmacy Examining Board of Canada

Figure 2—7 Number of Unique IPG Attempting Each of the PEBC Certification Steps (2002-2006) Year

2002

2003

2004

2005

2006

Total (2002–06)

Annual Average

Submitting Documents Evaluation

994

783

952

854

801

4,384

876

Attempting Evaluating Exam

531

657

787

753

754

3,482

694

Attempting Qualifying Exam Part I

323

449

518

626

704

2,620

524

Attempting Qualifying Exam Part II

254

382

446

459

626

2,167

433

Source: Pharmacy Examining Board of Canada “Unique IPGs” refers to the number of single individuals attempting any of the PEBC examination or document evaluation process. Numbers of unique IPGs are obtained by tracking only the final attempt made by an IPG on any exam, whether it be pass or fail, during the years 2002 to 2006. Final attempt includes both the single, non repeated attempts of each unique individual, as well as the final attempt of multiple attempts by each unique individual, whether it be that individuals 2nd, 3rd or 4th attempt) Any attempts beyond 2006 are not captured, therefore there is likely a certain number of IPGs who have gone on to make a later attempt at any of the examinations post 2006 and are therefore captured in the wrong category in this table.

The majority of IPG survey respondents (72%) indicated that they had their licence/ registration to practise as a pharmacist in a Canadian province. Licensed IPGs in the survey indicated a wide range of estimated amounts of time required for them to complete the licensing/registration process. As shown in Figure 2-8, while about one-quarter (24%) of IPGs completed their licensure in one year or less, 58% required two years or more. The average amount of time to complete licensure was 26 months, and the median time was 24 months. (The average length of time did not vary significantly when analyzing responses from IPGs in different areas of the country, although the number of responses was limited from many provinces.) 20

© 2008 Canadian Pharmacists Association

Section 2: Findings

Figure 2—8 Estimated Length of Time of Licensing/Registration Process for IPGs

Performance of IPGs in the PEBC National Pharmacy Examinations Figure 2-9 presents the Estimated Lenth of Time % pass rates of IPGs for all examination sittings 1 year or less 24% between 2002 and 2006, More than 1 year to less than 2 years 19% for each of the three 2 years or more 58% PEBC examinations. As demonstrated, pass rates n=750 Source: IPG Survey Q8c are somewhat higher for the Evaluating Examination than for either of the two parts of the Qualifying Examination. Pass rates are calculated based on number exams written at each exam sitting divided by the number of exams which are passed at that sitting. These statistics do not distinguish between individual IPGs over sittings, and care must be taken when using these statistics to illustrate performance by pass rates over multiple years.

Figure 2—9 Observed Pass Rates of IPGs in the PEBC Examinations (Total 2002-2006), First Attempts, Repeaters, and Total Pass Rates Among Pass Rates Among Pass Rates Among IPGs Making their IPG Exam Repeaters IPGs at All Sittings First Attempts Evaluating Exmaination

61%

54%

59%

Qualifying Exam Part I

44%

55%

49%

Qualifying Exam Part II

39%

54%

45%

Source: Pharmacy Examining Board of Canada. *Pass Rate for IPGs is calculated for each individual exam sitting, and represents the number of exams successfully passed by IPGs divided by the number of exams written.

Number of Attempts at PEBC Examinations As shown in Figure 2-10, during the period from 2002 to 2006, 74% of unique IPGs attempting the Evaluating Examination did so only once. Of these single attempters, 61% of those unique IPGs passed the exam on their first attempt. 26% of unique IPGs attempting the Evaluating Examination in that same time period did so multiple times. The remainder (13%) failed on their first attempt and did not repeat the exam during the time period studied. Some of these individuals may in fact go on to repeat the exam after 2007 and are not captured in the data. In addition, the PEBC also reports that IPGs may occasionally not repeat the exam due to failure to obtain the necessary visa to return to Canada for the exam (or other immigration procedural delays), or the IPG simply choosing another career that does not require a pharmacy license.17 By comparison, a much lower percentage of unique IPGs make only one attempt at the two parts of the Qualifying Examination. During the period of 2002 to 2006, 53% of unique IPGS attempting the Qualifying Examination Part I did so only once. Of these single attempters, 43% passed on their first attempt. However, a full 46% of unique IPGs attempting the Qualifying Examination Part I in that same time period did so multiple 17. Dr. John Pugsley, Pharmacy Examining Board of Canada.

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Figure 2—10 Percentages of Unique IPGs who Make Single Attempts (Successful and Unsuccessful) and Repeated Attempts at the PEBC Examinations (Total 2002-2006) % of Unique IPGs Passing on First Attempt (During 2002–2006)

% of Unique IPGs Failing on First Attempt and Not Repeating (During 2002–2006)

% of Unique IPGs Making Multiple Attempts (During 2002–2006)

Evaluating Examination

61%

13%

26%

Qualifying Exam Part I

43%

10%

46%

Qualifying Exam Part II

39%

12%

48%

Source: Pharmacy Examining Board of Canada Number of Unique IPGs is calculated based on the final attempt the IPG makes on a given exam. Attempts made beyond 2006 are not captured, therefore it is expected that a certain number of IPGs under the “% of Unique IPGs Failing on First Attempt and Not Repeating (During 2002-2006)” do in fact go on to attempt the exam in later years.

times. The remainder (10%) failed on their first attempt at the Qualifying Examination Part I and did not go on to repeat it during the time period studied. It is expected that a certain percentage of this remainder have attempted (or will attempt) Part I of the exam during 2007 or beyond. For the Qualifying Examination Part II, 51% of unique IPGs attempting this exam did so only once. Of these single attempters, 39% passed the Qualifying Examination Part II on their first attempt. A large 48% of unique IPGS attempting the Qualifying Examination Part II go on to make multiple attempts at this exam. The remainder (12%) failed on their first attempt and did not go on to repeat the exam during the time period studied. Similar to above, it is expected that a certain percentage of this remainder have attempted (or will attempt) Part II of the exam during 2007 or beyond. As a point of comparison, almost all domestic graduates took just one attempt at the Qualifying Examination Part I (94%) and the Qualifying Examination Part II (96%) during that period. Challenges Faced by IPGs in the Licensing and Registration Process IPGs felt that the PEBC Qualifying Examination, particularly the OSCE, was the most difficult part of the licensing process. About three-quarters of surveyed IPGs felt that the Qualifying Examination Part I (74%) and Qualifying Examination Part II (77%) were “difficult” or “very difficult”, with 19% rating Qualifying Examination Part I and 28% rating Qualifying Examination Part II as “very difficult”, respectively. The Evaluating Examination was also rated as “difficult” or “very difficult” by a majority (58%) of IPGs. Finding a practical training position was rated as “very difficult” by 26% of IPGs, and “difficult” by 28% of IPGs. In addition to the difficulties experienced with the examinations and the structured practical training, the time required to complete the licensing process was felt to be a challenge. IPGs often struggle with multiple demands on their time, including, in many cases, the demands of work, family, and preparing for exams. This can be especially difficult for recent immigrants, who may not have a strong support network in their new community, and who are adjusting to living in a new culture. One IPG focus group participant explained that s/he was working, studying for the PEBC exams, and looking after two small children while her/his spouse worked full-time. 22

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Section 2: Findings

Figure 2—11 Perceived Difficulty of Each Step in the Licensing/Registration Process Very Easy

Easy

Difficult

Very Difficult

PEBC Qualifying Exam Part II (Objective Structured Clinical Examination)

3%

21%

49%

28%

PEBC Qualifying Exam Part I (Multiple Choice Questionnaire)

1%

25%

55%

19%

PEBC Evaluating Exam

5%

37%

43%

15%

Finding a practical training position

13%

33%

28%

26%

Getting licensed/registered in your province

8%

45%

35%

12%

Meeting other educational requirements in your province (e.g., Ontario IPG program requirements, Quebec diploma equivalency education, etc.)

9%

48%

30%

13%

Meeting English or French fluency requirements

21%

42%

26%

10%

Having documents examined by PEBC

17%

57%

20%

6%

Provincial jurisprudence examination

23%

65%

11%

1%

Source: IPG Survey Q11 n=1,067 Percentages were calculated excluding “don’t know” responses.

The cost of examinations was also a barrier noted by focus group IPGs. The cost of the Document Evaluation in 2007 was $475, the Evaluating Examination was $460, the Qualifying Examination Part I is $300 and the Qualifying Examination Part II is $1,350. This brings a total cost of $2,220, providing the candidate passes each step. Failed examinations must be retaken and fees paid again for each examination. For many, these costs are high, particularly if they are in addition to the costs of taking required bridging or university programs. As one IPG in the focus groups said, “If my husband didn’t work, I wouldn’t be able to pay for the exams.” Others commented on the fact that they were unable to obtain loans or grants to help to cover the costs of licensure. Key informants from the provincial pharmacy regulatory authorities and provincial pharmacy associations also noted that high costs are a challenge for IPGs, especially those with families who have recently immigrated to Canada. Furthermore, IPGs often struggle to find the information they need on the licensure process and on how to find studentship, internship, or volunteer positions. Some IPGs feel they are not sufficiently prepared for the exams prior to their exam attempts. Key informants from provincial regulatory authorities, provincial pharmacy associations and pharmacy chains also highlighted the following barriers or challenges for IPGs in getting licensed or registered: • Difficulty finding practice sites for studentship/internship: IPGs are responsible for finding their own placements at pharmacies to complete their studentship/internship. Key informants indicated that it was difficult for IPGs to find these spots/placements. This was felt to be at least partly the result of the perception Integration of International Pharmacy Graduates into the Canadian Pharmacy Workforce: Barriers and Facilitators

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Section 2: Findings









that taking on an IPG for a studentship/internship would involve a lot of effort on the part of the employer or preceptor. The process of licensure is time-consuming: The process for obtaining a licence can be time-consuming, particularly if IPGs fail an exam and have to wait six months for the next session in order to re-sit the exam. Language barriers can complicate the process of finding information about the licensing process, and make the process of getting licensed very difficult. Language barriers can include not just knowledge of standard English, but also awareness of Canadian idioms, expressions and health care workforce terminology. Cultural differences related to pharmacy practice: IPGs often arrive in Canada from areas of the world where pharmacy practice is very different, sometimes requiring less direct patient care. An understanding of the Canadian model of practice is necessary to successfully complete the licensure process. A shortage of places in pharmacy university courses in Quebec was felt to be a barrier to licensure/registration. IPGs wishing to practise in Quebec must attend university courses at one of Quebec’s two faculties of pharmacy, but spaces are limited.18

Additional Programs or Services Needed to Support IPGs on the Path to Licensure Surveyed IPGs feel that more support is needed for them on the path to licensure. Among all surveyed IPGs, 48% said they felt there was a need for additional bridging programs or other mechanisms to support IPGs while they are becoming licensed/registered as Canadian pharmacists. Only 26% said they did not feel more was needed and 25% said they did not know or were unsure. While regional comparisons should be viewed with caution due to the small number of IPG respondents outside of Ontario, the proportion of IPGs saying more programs or supports were needed was higher in Quebec and in western provinces than in Ontario. Those IPGs who felt that additional supports were needed were asked to provide their suggestions on what specific types of supports or programs were needed. Responses to this open-ended question were then coded. The results show that 28% said that more practical opportunities were needed. In addition, 15% noted that less expensive alternatives to existing bridging programs and courses were needed, 15% said that refresher courses to help prepare for examinations were needed; and 15% said that they feel language training was needed. In the focus groups, IPGs indicated that a significant challenge in the licensing process was a lack of one comprehensive source of information to explain the process of getting licensed. While many IPGs felt that a lot of information was available through sources like the PEBC website, it was also noted that they lacked access to an easy-to-understand source that clearly outlined all the steps in the process of integrating into the Canadian pharmacy workforce. Many focus group respondents also noted that they felt somewhat isolated throughout the process of licensure, and would have liked to have been able to connect with others who were either in the process of licensure, or who were licensed to practice. Some focus group participants felt that there was a need for an online chat room or some other type of online forum for internationally educated health workers in Canada, or, better still, specifically for IPGs. 18. According to faculty websites, availability may be restricted depending on the number of Quebec applicants or reserved for international students from developing countries.

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Figure 2—12 Additional Program/Services that IPGs Feel Are Needed to Support Them on the Path to Licensure/Registration* Programs and supports that provide opportunities to gain practical work experience

28%

Less expensive alternatives to existing bridging support programs/financial support

15%

Refresher courses to help preapre for exams/ preparation courses

15%

Language training

15%

Training on how to deal with cultural differences

13%

Additional bridging and support programs offered in diffierent cities

6%

More flexible/part-time bridging and support programs

5%

University-based programs

4%

A support system designed to give IPGs specific information on how to navigate the Canadian pharmacy system

2%

Other

8%

0%

5%

10%

15%

20%

25%

30%

n=469 Source: IPG Survey Q13b *As a result of multiple responses, totals may add up to more than 100%.

Most employers (48%) also reported that there is a need for additional programs/services designed to support IPGs while they are on the path to licensure/registration as Canadian pharmacists (16% of employers reported that they do not feel that there is a need for additional programs/services to support IPGs and 36% of employers indicated that they did not know). Those employers who felt that additional supports were needed were asked to provide their suggestions on what specific types of supports or programs were needed. Responses to this open-ended question were then coded. Most employers (48%) reported that additional “language/communication skills training” program/services are needed. At 19%, “more practical/clinical training” was the second most common response, followed by “cultural integration courses/programs to help with understanding of the Canadian health care system” (18%).

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Section 2: Findings

Supports Being Offered by Employers Although the majority of employers (57%) reported that they do not offer any kind of support specifically to IPGs (beyond general employment training or orientation), a portion of employers did indicate that they offer some type of support. Figure 2-13 illustrates the proportion of employers offering different types of supports specifically for IPGs during the licensure process. Internships, student positions and mentoring were the most common responses, with 20%, 17% and 16% of employers respectively indicating they offered these supports.

Figure 2—13 Supports Offered Specifically to IPGs by Employers None

57%

Internships

20%

Student positions

17%

Mentoring

16%

Financial assistance with licensing/ registration examinations

7%

PEBC examination process preparation

6%

Settlement assistance

6%

Tuition support for bridging programs

5%

Language training

4%

Other

4%

0%

10%

20%

30%

40%

50% 60%

n=315 Source: Employer Survey Q4 As a result of multiple responses, totals may total more than 100%.

Enablers of Success in the Licensing and Registration Process Key informants were asked what would help IPGs to overcome the barriers and challenges that they face in the licensing and registration process. The bridging programs offered through U of T and UBC were often identified as being excellent methods to overcome the challenges of the licensure process, even though the overall goal of these programs is to prepare IPGs for a career of pharmacy practice. 65% of surveyed employers also felt that bridging program were effective in assisting IPGs in becoming pharmacists in Canada. However, bridging programs are not available in all provinces. There was felt to be a need for IPGs to access the same types of programs across Canada, rather than being confined to specific locations. A bridging program was said to be in development in the province of Quebec, but 26

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Section 2: Findings

presently there was no bridging program available in that province. Furthermore, IPGs without financial assistance or help from employers may often lack the funds to pay for the costs of these programs, or the resettlement costs required to attend them. In addition, both employers and key informants felt that mentorship was effective in helping IPGs to overcome some barriers and challenges. In the survey of employers, 62% stated that mentorship was effective in helping IPGs to become pharmacists in Canada. While some mentorship has been available through the bridging programs, and other sources such as MISA in Nova Scotia, there was felt to be a need for more mentorship opportunities. Key informants also felt that employers should be encouraged to take on IPGs who require practice sites for their internship/studentship. Similarly, most employers felt that structured practical training (69%) and practice opportunities provided by employers (64%) were effective in assisting IPGs in successfully obtaining their license and integrating into practice. Some IPGs in the focus groups found working as pharmacy technicians was helpful insofar as it allowed them to work in the field of pharmacy during the process of obtaining their license to practice pharmacy, while still being able to earn the money they needed to help pay for the costs of licensure and the costs of living and having a family. Finally, key informants often felt that there should be more information available to IPGs about the steps involved in licensing/registration process. Perceived Effectiveness of Licensing Process Over one-half of key informants from the provincial pharmacy regulatory authorities, provincial associations, and large pharmacy chains feel that the licensing process is appropriate and effective for IPGs, but a significant minority (a little less than half) did not. Some key informants felt that the internship19 process and requirements for IPGs were not appropriate or effective in all provinces. The lack of consistency in the licensing requirements between provinces was also felt to be an issue. Some felt that the number of hours required for internship in Ontario is too long, especially in comparison to other provinces. Others noted that the requirement that IPGs undertake internship after the Qualifying Examination (as is the case in Ontario) was not appropriate, and that internship can be useful to help IPGs prepare for the Qualifying Examination. Another identified issue was the frequency of PEBC examinations. Eligibility for the Qualifying Examination for IPGs is contingent on successful completion of the Evaluating Examination. The Evaluating Examination, and the Qualifying Examination Part I and Part II are only offered twice per year and candidates who are not successful in examination attempts at any phase must wait six months to retake that examination. As such, it was suggested that examinations be offered more frequently. Key informants also identified English (or French) language fluency as an issue that should be addressed. For example, it was suggested that language fluency requirements should be more stringent, and that sufficient language fluency should be mandatory at an early stage in the licensing process. 19. In some provinces this is called a ‘studentship’.

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Section 2: Findings

Key informants noted that the process by which IPGs’ foreign educational credentials are assessed in Quebec can be very time-consuming. IPGs are often required to take multiple classes at one of Quebec’s two faculties of pharmacy in order to be deemed equivalent to Quebec graduates. This process was felt to be often quite lengthy, depending on when the required classes are offered and the number of seats available.

Bridging Programs Current Bridging Programs Available for IPGs Bridging programs are available to help IPGs become pharmacists in Canada. Bridging programs are formal, post-degree programs of study designed to address gaps between an IPG’s education or experience and standards of pharmacy practice in Canada. Bridging programs are not post-graduate degree programs, such as a PharmD or master’s program. Bridging programs are a relatively new phenomenon in Canada, with all of the bridging programs/courses identified in this report having existed for less than six years. A number of bridging programs and courses are available for IPGs. Interviews with representatives of nine of the 10 bridging programs identified in the research were undertaken.20 According to interviewees, approximately 225 IPGs are currently enrolled in a bridging support program or course. Figure 2-14 provides an overview of these programs. Currently, only the OCP has a mandatory, although exemptible,21 requirement for completing a specific bridging program as a condition of licensure.

Figure 2—14 Bridging Programs and Courses Available to IPGs in Canada Canadian Pharmacy Skills (CPS): University of Toronto (Toronto, Ontario)

The CPS program provides training for entry to practice competence.The program is offered full-time in two eight week sessions. The program is offered in the spring and fall. The CPS program is a mandatory but exemptible requirement to become a licensed pharmacist in Ontario.

Enhanced Language Training (ELT) for Internationally Educated Health Professionals(IEHPs): University of Toronto (Toronto, Brampton, Scarborough, and Mississauga, Ontario)

The ELT program develops the language skills required to communicate within a health profession in Canada and to meet the fluency requirements for licensing by the Ontario College of Pharmacists. This program runs three hours per week for fifteen weeks.

20. Despite repeated attempts, one bridging/support program could not be reached for detailed information. 21. Anyone who has graduated from a program accredited by the American Accreditation Council for Pharmacy Education (ACPE) is exempt from the IPG program. This includes not only all American programs, but also the PharmD program at the University of Lebanon. Similarly IPGs who successfully complete the PEBC Qualifying Exam Parts I and II may go to a panel of the registration committee and request an exemption from the IPG program.

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Figure 2—14 (continued) Bridging Programs and Courses Available to IPGs in Canada Canadian Pharmacy Practice Programme (CP3): University of British Columbia (Vancouver, British Columbia)

The CP3 program is designed to allow internationally trained pharmacists to achieve the competencies required for practice in Canada. This is a live, 24 hours per week, 20 week program. Sessions are offered in the spring and the fall. The CP3 program is not a requirement to become a licensed pharmacist in British Columbia.

OSCE Preparatory Course: Agro Health Associates (Burlington, Ontario)

The purpose of this course is to develop communication skills and instil the key competencies of pharmaceutical care to assist IPGs in preparing for the OSCE component of the licensing/registration process. It is a live, five-day, full-time (40 hours) program offered twice per year, immediately prior to the PEBC examinations.

International Pharmacy Bridging Program: Bredin Institute Centre for Learning (Edmonton and Calgary, Alberta)

The International Pharmacy Bridging program is designed to help IPGs develop and hone the professional knowledge and skills necessary to acquire their license to practice pharmacy in Alberta. The program is a full-time, 41-week commitment that includes the completion of 500 hours of structured practical training. The program is offered twice per year and includes intensive OSCE preparation. The majority of students will receive a 24-week grant to help cover expenses. Completion of this program is not required by the Alberta College of Pharmacists as a condition of licensure/registration in Alberta.

Prescription for Learning: Communication Skills for the Practice of Pharmacy — Emerald Educational Services (Winnipeg, Manitoba and Edmonton, Alberta)

The program is designed to assist the integration of IPGs into the Canadian workforce, either during their internship phase of the licensing process or for those newly licensed IPGs who may benefit from participating in the course. It combines communication techniques and knowledge of the workplace with topics and issues facing IPGs when working in a Canadian pharmacy. The program is a 49-hour course delivered in-classroom setting over seven weekly seven-hour sessions. Program costs range from $350–$700 with possible funding opportunities from provincial governments.

Orientation to the Canadian Health Care System: Assessment Centre for Internationally Educated Nurses, Professional Development Centre (Halifax, Nova Scotia)

This program is designed to assist internationally educated health care professionals in integrating and finding employment in Nova Scotia. The purpose of the program is to provide an overview of health care professions in Canada and Nova Scotia. The program runs for 10 weeks with three-hour sessions once per week. It runs twice per year (spring/fall). The program is free of charge.

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Section 2: Findings

Figure 2—14 (continued) Bridging Programs and Courses Available to IPGs in Canada Skills Lab Training: Metropolitan Immigrant Settlement Association (Halifax, Nova Scotia)

The program gives IPGs the opportunity to practice communication techniques, gain pharmaceutical knowledge and prepare for the OSCE. The programis facilitated by registered pharmacists, demonstrators, and professional simulated patients. The program is a 12-16 hour course delivered over six to eight weeks in a classroom setting. It is available twice a year in the spring and fall.

International Pharmacy Graduate On-Site Program: Metropolitan Immigrant Settlement Association (Halifax, Nova Scotia)

The On-Site Program is an on-the-job program designed to familiarize IPGs with the professional pharmacy environment in Canada. It introduces them to interactions among patients, pharmacists, and pharmacy technicians. The program can be taken on a full-time or part-time basis and typically takes 14 weeks to complete. It should be taken after successful completion of the PEBC evaluating exam.

The most extensive programs for IPGs are those offered through U of T (the CPS program) and UBC (the CP3 program). These programs consist of modules, some of which can be taken separately. Courses in the programs cover clinical skills and collaborative practice, with communication skills provided throughout the program. In Ontario, OCP is examining whether or not the IPG program at U of T should be exemptible for IPGs. No other provincial regulatory authority indicated that they expected changes to the licensing/registration process in the near future. No bridging programs currently exist in Quebec. According to key informants in that province, a university-based bridging program for IPGs is currently under development. Through a Health Canada grant, Austin and Rocchi are piloting an Orientation to Canadian Health Care Systems, Culture and Context course for internationally educated health professionals that will be available on a pan-Canadian basis in various locations, and online. In addition to the bridging programs offered through universities and private trainers, one chain drug store was said to be developing a bridging program for IPGs. Although the program was under development at the time of the research interview, the key informant from the chain described the program as involving a six-month program of classroom and practical training, including a mock-OSCE component. According to the key informant, this program was being developed due to the difficulties that the chain was having in recruiting domestically educated graduates for its pharmacies in small towns in more remote locations of the country. The cost of taking a bridging course or program varies depending on the length and/or type of course. The most extensive programs, offered through the U of T, UBC or the Bredin Institute in Alberta, are $10,000 or more.

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Section 2: Findings

Figure 2—15 Tuition Costs of Bridging Programs and Courses for IPGs Bridging Program/Course

Cost of Tuition

University of Toronto, Canadian Pharmacy Skills I & II

$13,000.00

Bredin Institute, International Pharmacy Bridging Program

$12,000.00

University of British Columbia, Canadian Pharmacy Practice Program

$10,000.00

Agro Health Associates, OSCE Preparatory Course

$2,000.00

Emerald Educational Services, Communication Skills for the Practice of Pharmacy

$350–$700

University of Toronto, Enhanced Language Training for IEHPs

Free of charge

Metropolitan Immigrant Settlement Association, Skills Lab Training

Free of charge

Metropolitan Immigrant Settlement Association, IPG On-Site Program

Free of charge

Assessment Centre for Internationally Educated Nurses Professional Development Centre, Orientation to the Canadian Health Care System

Free of charge

Source: IPG Bridging and Support Program Factsheets

Awareness and Usage of Bridging Programs About one-half (52%) of surveyed IPGs indicated that they were aware of the available bridging programs. Given that there are currently no available bridging programs in Quebec, awareness of bridging programs was lowest there, with only 37% of IPGs living in Quebec saying they were aware of bridging programs. Bridging programs are using many different venues to publicize themselves among IPGs. The university-based programs appear to be well publicized through the provincial pharmacy regulatory authorities, provincial pharmacy associations, as well as through employers and immigrant settlement agencies. The other (non-university-based) programs are generally more reliant on word-of-mouth, and some use other venues of advertising, including libraries and faxes to pharmacies. Overall, representatives of the bridging programs felt that through these methods they are reaching the target group of potential IPGs in their geographic areas. One program provider felt that the methods being used work well for those who have recently arrived in Canada, but may not be reaching those who have been in Canada for many years, have become somewhat disconnected from the pharmacy system, and are hoping to now enter the Canadian pharmacy workforce. Among IPG survey respondents, 60% have never participated in an IPG bridging program, and have no plans to register for one in the future. About one-fifth (21%) of IPGs have had some involvement with an IPG bridging program with 14% indicating they have successfully completed one.

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Section 2: Findings

Figure 2—16 Experience of IPGs with Canadian Bridging Programs Never participated in an IPG bridging program and have no plans to register for one in the future

60%

Successfully completed an IPG bridging program Participated in an IPG bridging program in the past, but did not complete all the requirements

14%

3%

Currently participating in an IPG bridging program

2%

Registered for, but no yet started, an IPG bridging progam

2%

Don’t know/Unsure

20%

0% 10% 20% 30% 40% 50%

60%

70%

n=1,067 Source: IPG Survey Q14

The majority (61%) of IPG survey respondents who had participated in an IPG bridging program had attended U of T’s CPS I and CPS II. UBC’s CP3 program was the second most common response (7%), followed by the International Pharmacy Bridging Program offered at the Bredin Institute Centre for Learning in Alberta (5%). Representatives from the bridging programs and courses have, over recent years, all seen their enrolment numbers either remain steady or, more commonly, grow. This trend is expected to continue in the near future, as nearly all respondents expect their numbers to continue to increase. Representatives from the bridging programs and courses stated that most IPGs follow the programs to completion, and those few learners who do not complete the programs do so as a result of personal rather than professional reasons. One respondent, however, suggested that IPGs might leave mid-way through a program, when they feel they are sufficiently prepared to pass the OSCE. In many of these cases, however, these IPGs are not successful at the OSCE and do return to complete the program. In general, however, across all programs, most IPGs were said to be completing their programs. Reasons IPGs Do or Do Not Participate in a Bridging Program IPGs who have participated in a bridging program most often do so in order to help prepare for the PEBC examinations. 37% of IPGs stated that they were primarily undertaking the IPG program to help prepare for the exams, whereas 20% stated that they were taking the program primarily to improve their pharmacy skills and knowledge, or to meet provincial licensing/registration requirements.

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Section 2: Findings

Figure 2—17 Primary Reason Cited for Having Participated in an IPG Bridging Program To help prepare for the PEBC examinations

37%

To improve my pharmacy skills and knowledge

20%

To meet provincial licensing/registration requirements

20%

To understand the roles and responsibilities of being a pharmacist in Canada

11%

Don’t know/Unsure

8%

Other

5%

0% 5% 10% 15% 20% 25% 30% 35% 40% n= 219 Source: IPG Survey Q15b

Figure 2—18 Reasons Cited for Having Not Participated in an IPG Bridging Program Did not need it

51%

Not aware of any IPG bridging programs

27%

Did not have the money to take an IPG bridging program

17%

No IPG bridging programs in my area

14%

IPG bridging program was too long/ involved too much time

9%

Could not take the IPG bridging program because of family commitments

7%

Did not meet all the requirements of the IPG bridging program IPG bridging program seemed too difficult

3%

1%

Don’t know/Unsure

6%

0%

10%

20%

30%

40%

50%

60%

n= 634 Source: IPG Survey Q16 As a result of multiple responses, totals may add up to more than 100%.

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Section 2: Findings

At the same time, 51% of IPGs who have no experience with bridging programs selected “they did not need it” as the most common reason for not participating in an IPG bridging program. Other common reasons included IPGs not being aware of the bridging programs (27%), IPGs not having the money to take an IPG bridging program (17%), or there being no available bridging program in their geographic area (14%). In the Toronto IPG focus group, while not all IPGs had taken the U of T bridging program, there was a sense among most of the participants that the program was useful and helpful. Some felt, however, that they did not need the program. As one participant stated, “the things you need to know you learn in the pharmacy, not from books.” In the Edmonton focus group, no IPGs had taken a bridging program. While IPGs were generally aware of the Alberta program offered through the Bredin Institute, and some were familiar with U of T’s IPG program, they had generally not participated in these programs, either for financial reasons or because they felt that they did not need it. One IPG did not take the Bredin program because he or she could not meet the program’s requirement that they pass the Evaluating Examination. Perceived Effectiveness of Bridging Programs IPGs appear to be benefiting from bridging programs in a variety of ways. IPGs with experience in the bridging programs generally stated that many components of the programs were effective or very effective. As shown in Figure 2-19, information received about pharmaceutical care, applied therapeutics, and the roles and responsibilities of pharmacists in Canada were all rated as effective or very effective by over three-quarters of IPGs who had taken the programs. Key informants, including those from the programs themselves, echoed the comments made by IPGs regarding the perceived benefits of bridging programs. They felt that the programs provided IPGs with information and practical knowledge to help address cultural differences, communication skills, and to provide important information related to pharmaceutical care. Overall, key informants felt the programs aided IPGs’ transition to Canadian pharmacy practice, and were invaluable in assisting in the licensure process. The programs also claim higher PEBC examination success rates among program completers. The U of T CPS program has reported that among IPGs who have successfully completed all components of the program, 96% have been successfully licensed.22 Key informants interviewed for the study also stated that the bridging programs at U of T and UBC were particularly effective in providing information to help IPGs to obtain licensure and practise as pharmacists in Canada. As there is currently no national accreditation system for IPG bridging programs and courses, the extent to which all programs are meeting the needs of IPGs is not known. Several key informants noted, however, that the existing bridging programs are not appropriate for all IPGs. Some courses were felt to be inappropriate for those coming with extensive relevant pharmacy experience and fewer cultural barriers, such as, for example,

22. Austin, Z, Rocchi Dean, M. Bridging education for foreign-trained professionals: the International Pharmacy Graduate (IPG) Program in Canada. Teaching in Higher Education. Jan 2006;11(1):19-32.

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Figure 2—19 Perceived Effectiveness of IPG Bridging Program Components Effective/Very Effective

Not Very Effective/ Somewhat Effective

Don’t Know/ Not Applicable

Information you received about pharmaceutical care (diseases and therapeutics)

83%

7%

10%

Information you received about applied therapeutics

80%

9%

11%

Information you received on the roles and responsibilities of pharmacists in Canada

79%

12%

9%

Information you received about the licensing/registration process and requirements

73%

15%

12%

Ability to meet your peers

73%

17%

11%

Information you received about workplace behaviour and expectations in Canadian pharmacies

69%

18%

13%

Ability to interact with established practitioners and pharmacists

65%

26%

9%

Assistance in getting your pharmacist license/registration in Canada

63%

23%

14%

Respect for your prior experience and education

57%

32%

11%

n= 219 Source: IPG Survey Q15c

experienced pharmacists coming from the United Kingdom. One key informant suggested that the applicability of the programs be evaluated on a case-by-case basis, rather than the programs being mandatory (although exemptible), as is currently the case in Ontario. Perceived Gaps in Program Delivery Almost half (48%) of IPG respondents indicated that they felt there is a need for additional bridging programs or other supports for IPGs while they are becoming licensed/registered as pharmacists. While the existing bridging programs are largely seen as effective, they are not seen as accessible across Canada. Many key informants felt that IPGs outside of Toronto and Vancouver have limited access to such programs. Major areas of the country, including Quebec, Atlantic Canada (outside Halifax) and others, could benefit from better access to similar programs. The prospect of using computer-based delivery for the program was felt to be a possible solution to addressing this gap.

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Section 2: Findings

The cost of the programs is also a limitation for some IPGs. While some large employers will sponsor IPG participation in bridging programs, many IPGs do not have employer sponsorship. Some focus group members indicated that they did not take bridging programs because the costs were too high and, as some of the programs are full-time, they are unable to work while enrolled. Some key informants felt that more government support could help to address at least some of the costs borne by IPGs in taking the programs. Several providers of bridging programs and courses similarly noted that financial support to help with tuition and living costs would assist many IPGs to take their programs. One key informant noted that the focus of the bridging programs was such that it did not adequately prepare IPGs for working in hospitals or other health care facilities.

Working in Canada As demonstrated earlier, most IPGs expect that they will, at some point, work as pharmacists after settling in Canada. The majority of surveyed IPGs indicated that they have tried to find work as either a pharmacist (72%) or a pharmacy technician (61%) since arriving in Canada. Despite the many challenges evident throughout the licensing process, 70% of IPG survey respondents reported that they have at some point worked as a pharmacist in Canada. While the survey findings may not fully represent those IPGs who are completely disconnected from pharmacy in Canada (and who would not have heard about the opportunity to participate in the survey), they demonstrate that many IPGs do go on to practise, despite the many challenges of settling in a new country and obtaining licensure. Profile of Employment of IPGs

Figure 2—20 Employers Who Have Hired IPGs For Different Positions (During 2005–2007) All Employers*

Health care Facilities

Chain, banner or franchise

Independent

Full-time Licensed Pharmacist

25%

19%

27%

27%

Part-time Licensed Pharmacist

12%

4%

12%

20%

Casual/Locum/Relief Licensed Pharmacist

19%

7%

30%

11%

Intern

20%

19%

26%

13%

Student

14%

13%

18%

10%

Volunteer

6%

4%

5%

10%

Hospital Resident



0%





16%

16%

18%

13%

IPG Hired as:

Pharmacy Technician

n=315 Source: Employer Survey Q1 Percentages were calculated excluding “don’t know” category. *Includes employers that categorised themselves as being an “other” type of pharmacy

36

© 2008 Canadian Pharmacists Association

Section 2: Findings

A significant minority of pharmacy employers have hired IPGs recently. About four in 10 (44%) of surveyed pharmacist employers indicated that they had hired at least one IPG during the past three years. As demonstrated in Figure 2-20, employers are most likely to hire IPGs as full-time licensed pharmacists, but many are also hiring IPGs for other positions, including as interns and casual/locum/relief pharmacists. 16% of surveyed employers had hired at least one IPG as a pharmacy technician over the last three years. Figure 2-21 shows the proportion of employers who hired domestic graduates for different positions. Figure 2-22 illustrates the immigration or residency status of IPGs when they were made offer(s) of employment. IPGs are most often made an offer of employment while they are permanent residents or landed immigrants. Many IPGs are also offered employment when they are full Canadian citizens. Employers are making offers of employment to IPGs at various stages of the licensure process, most commonly after the Evaluating Exam, or after the IPG had worked for up to five years in Canada as a licensed pharmacist. Figure 2-23 illustrates at what step in the licensing/registration and practice process IPGs were when employers made their offers of employment.

Figure 2—21 Employers Who have Hired Domestic Pharmacy Graduates For Different Positions (During 2005-2007) Domestic Pharmacy Graduate Hired as:

All Employers*

Health care facility

Chain, banner or franchise

Independent

Full-time Licensed Pharmacist

65%

59%

75%

53%

Part-time Licensed Pharmacist

37%

26%

43%

38%

Casual/Locum/Relief Licensed Pharmacist

42%

46%

46%

36%

Intern

25%

25%

34%

10%

Student

48%

54%

54%

36%

Volunteer

9%

8%

7%

12%

Hospital Resident

4%

14%





n=315 Source: Employer Survey Q1 Percentages were calculated excluding “don’t know” category. *Includes employers that categorised themselves as being an “other” type of pharmacy

Integration of International Pharmacy Graduates into the Canadian Pharmacy Workforce: Barriers and Facilitators

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Section 2: Findings

Figure 2—22 Percentage of IPGs Hired at Different Stages of Immigration (as reported by hiring employers 2005–2007) Permanent resident/landed immigrant

34%

Canadian citizen

24%

In Canada under a temporary work permit

6%

In Canada under a student visa

4%

Application for permanent residency approved

3%

In Canada on visitor’s visa

2%

Not yet applied for entry to Canada

2%

Other immigration status (e.g., refugee) Don’t know/Unsure

1% 25%

0% 5% 10% 15% 20% 25% 30% 35% 40% n=131 Source: Employer Survey Q2b Categories are mutually exclusive; however employers may have more than one IPG in each category.

IPGs are finding work in a variety of different types of pharmacies in Canada. As reported earlier, 70% of IPG survey respondents indicated that they have worked at some point as a pharmacist in Canada. As shown in Figure 2-24, while over one-half (52%) of these IPGs have worked as pharmacists for pharmacies that are franchises or part of chains, 34% have worked in independent pharmacies, 12% in health care facilities, and 2% in other pharmacies. IPGs tend to find work in pharmacies in Canada’s cities. However, a large proportion of IPGs is working as pharmacists in many mid-size or smaller cities, not just in the largest urban centres. For those IPG respondents who indicated that they have worked as a pharmacist in Canada, Figure 2-25 outlines the size of the community where their pharmacy was located. Many IPGs are resettling within Canada to work as pharmacists. Of those IPG respondents who indicated that they had worked as a pharmacist in Canada, 31% said that they had to move away from the city or province where they first settled in Canada in order to work as a pharmacist. Many IPGs are finding work as pharmacy technicians. Among surveyed IPGs 46% stated they had worked as a pharmacy technician at some point since arriving in Canada. Working as a pharmacy technician can be an interim, short-term position that IPGs use to get experience until they can become licensed pharmacists. However, some IPGs are working as pharmacy technicians as a result of not being able to achieve their goal of becoming a pharmacist. 38

© 2008 Canadian Pharmacists Association

Section 2: Findings

Figure 2—23 Percentage of IPGs Hired at Different Stages of Licensure Process (as reported by hiring employers 2005–2007) Successfully completed the PEBC Evaluation Examination

16%

Had practised for 0–5 years as a registered/ licensed pharmacist in Canada

13%

Was in the process of fulfilling other provincial licensing /registration requirements

11%

Successfully completed Part I of the PEBC Qualifying Examination

11%

Had not completed any licensing/registration requirements or examinations

11%

Successfully completed Part II of the PEBC Qualifying Examination

8%

Had completed part or all of an IPG bridging program

8%

Successfully received provincial licensure/ registration to practice but not yet practising Had practised for 6 or more years as a registered/ licensed pharmacist in Canada

6%

5%

Don’t know/Unsure

12%

0% 2% 4% 5% 6% 8% 10% 12% 14% 16% 18% n=131 Source: Employer Survey 2c Categories are mutually exclusive; however employers may have more than one IPG in each category.

For many IPGs, working as a pharmacy technician is a frustrating disappointment. Focus groups revealed that many IPGs working as pharmacy technicians were negative about their current position. One IPG stated that it leads to a loss of identity to have to regress from the type of position they were able to hold in their home country.

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Section 2: Findings

Figure 2—24 Types of Pharmacies Where IPGs Have Worked as Pharmacists in Canada 2% other 12% Health care institution (hospital, long term care)

52% Chain, banner or franchise pharmacy

34% Independent community pharmacy

Source: IPG survey Q21a n=747 n=747 Source: IPG Survey Q21a

Figure 2—25 Size of the Community Where IPGs Have Worked as Pharmacists Urban centre of 500,000 people and over

37%

Urban centre of 100,000 to less than 500,000 people

32%

Urban centre of 5,000 to 100,000 people Rural area (less than 5,000 people)

28% 4%

0% 5% 10% 15% 20% 25% 30% 35% 40% n=747 Source: IPG Survey Q22

Perceptions of Employers Among those surveyed employers who had not hired an IPG within the last three years (Figure 2-26), the most common reasons included that they have not had any job applications from IPGs (35% of employers), or have not done any recent hiring of pharmacists (32%). A much smaller proportion of these employers gave reasons related to the quality of IPGs’ résumés (5%), language proficiency (5%), or qualifications (4%).

40

© 2008 Canadian Pharmacists Association

Section 2: Findings

Figure 2—26 Reasons Given by Employers For Having Not Hired Any IPGs During the Last 3 Years Have not had any job applications from IPGs

35%

Have not done any recent hiring of pharmacists

32%

Not sure how to find IPGs to hire

8%

Resumes of IPG applicants did not meet typical Canadian standards

5%

IPG applicants lacked sufficient English/ French language proficiency

5%

IPG applicants did not meet qualifications for position

4%

Patients/clients are less receptive to/accepting of IPGs Would require too high a level of investment in retraining and supervising Liability/insurance concerns Other

3%

2%

1% 0.40%

Don’t know

6%

0% 5% 10% 15% 20% 25% 30% 35% 40% n=184 Source: Employer Survey Q3

Figure 2—27 Likelihood that Employers would Hire an IPG in the Next 3 Years for Different Positions Likely/Very Likely

Neutral

Unlikely/Very Unlikely

Don’t Know

Pharmacy manager or supervisor

13%

8%

62%

18%

Staff pharmacist

25%

23%

37%

14%

Pharmacy technician or assistant

25%

20%

43%

13%

n=315 Source: Employer Survey Q8

Integration of International Pharmacy Graduates into the Canadian Pharmacy Workforce: Barriers and Facilitators

41

Section 2: Findings

As show in Figure 2-27,only one-quarter (25%) of surveyed employers expected, over the next three years, to hire an IPG as either a staff pharmacist or a pharmacy technician/assistant. A smaller proportion (13%) expected to hire an IPG in the next three years as a pharmacy manager or supervisor. Of those employers in focus groups who had not employed IPGs in the past, most said that this was a result of not needing to hire additional workers. One employer noted that his or her pharmacy lacked the resources to train and supervise an IPG, implying that an IPG would require more training or supervision than a domestically educated graduate. Overall, employers were more likely to be neutral or to disagree with statements suggesting that IPGs had particular needs compared to Canadian pharmacy graduates. They were more likely to disagree that IPGs require more supervision or training than Canadian graduates, and did not agree that IPGs need specialized support to meet entryto-practice standards or bridging programs to successfully practice pharmacy in Canada.

Figure 2—28 Employer Perceptions of the Needs of IPG Employees Strongly Strongly Neutral Don’t Know Agree/Agree Disagree/Disagree IPG employees require more supervision than Canadian graduates

16%

19%

49%

16%

IPGs require specialized support in order to meet Canadian entry-to-practice standards and become licensed/registered

7%

20%

56%

17%

IPG employees require more training than Canadian graduates

15%

22%

42%

22%

IPG require specialized bridging education to successfully practise pharmacy in Canada

8%

19%

56%

17%

n=315 Source: Employer Survey Q7

Key informants from provincial pharmacy regulatory authorities, associations, and large pharmacy chains were asked if pharmacy employers generally had any concerns related to hiring IPGs. Some key informants mentioned that employers may, at times, have the following concerns: • Language issues, or even strong accents, can be a concern, particularly for those outside of large cities; • Employers feel that IPGs are reluctant to leave big cities for employment in smaller communities, where they often have less support and fewer opportunities for strong ties to ethnic communities. • There is a feeling that there are cultural and language barriers between IPGs and patients, particularly outside of large urban areas. Employers may feel that IPGs will not be able to relate to their patients.

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© 2008 Canadian Pharmacists Association

Section 2: Findings

Benefits of Hiring IPGs Employers were divided on the extent to which they agreed that employing IPGs generally provided benefits for their pharmacy, (Figure 2-29). Employers were generally positive about the amount of experience that IPGs bring to pharmacy practice and were more likely to agree (39%) than disagree (17%) that IPGs are more experienced than Canadian graduates. Similarly, employer focus group participants commented that many IPGs were extremely knowledgeable about drug interactions and specific chemical properties. One participant noted that often IPGs “know by heart information that Canadian pharmacists have to look up in reference material.” In interviews, key informants noted that IPGs are often older and more experienced in pharmacy practice than domestically educated pharmacists. Surveyed employers did not generally agree that IPGs provide important cultural or language benefits to their pharmacy’s patients/clients, or valuable new or alternative health information and approaches to practice. However, in focus groups, some employers noted that a more multicultural society benefits from a more multicultural pharmacy workforce. Pharmacies with IPGs often offer patients more cultural and language diversity. This was felt to result in improved service and patient care, particularly in large urban centres.

Figure 2—29 Employer Perceptions of the Benefits of IPG Employees Strongly Strongly Neutral Don’t Know Agree/Agree Disagree/Disagree IPGs are generally more experienced than new Canadian graduates

39%

19%

17%

25%

IPG employees provide access to new patients/clients

24%

30%

27%

19%

IPG employees provide valuable new/alternative health information and approaches to practice

18%

31%

34%

18%

IPG employees provide important cultural or language benefits to my patients/clients

18%

27%

39%

16%

IPG employees are more willing than Canadian graduates to work in under-served areas

17%

14%

34%

34%

n=315 Source: Employer Survey Q7

Integration of International Pharmacy Graduates into the Canadian Pharmacy Workforce: Barriers and Facilitators

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Section 2: Findings

Barriers or Challenges to IPG Success As demonstrated in Figure 2-30, IPGs most often felt that various aspects of the licensing process were the major barriers to their success in the Canadian pharmacy workforce. Many felt that the financial burden of the licensing process was particularly challenging (44% identifying this as a barrier or significant barrier). In addition, 41% of IPGs felt that the length of time required for the licensing process was a barrier, while 35% said that the lack of resources to assist in preparation for licensing was a barrier. In addition to the challenges of completing the often difficult process of becoming licensed to practice, Figure 2-30 also illustrates other challenges related to finding employment and working as a pharmacist in Canada that were identified by both employers and IPGs. These challenges to IPGs’ success in the pharmacy workforce are generally related to two areas: communication skills and cultural differences that impact practice. Communication Skills Communication skills in pharmacy practice include not only general English (or French) language proficiency, but also relate to knowledge of Canadian idioms and expressions, and to proficiency in communicating with clients and other health care providers. Employers overwhelmingly identified communication issues as the major barrier affecting IPGs’ success. About two-thirds (67%) of surveyed employers identified a lack of proficiency in communicating effectively with patients/clients and a lack of proficiency in spoken and written English/French (67% and 60% respectively) as barriers to IPGs success. Further, 55% of employers felt that a lack of proficiency in communicating effectively with other pharmacists was a barrier for IPGs. Employers who had hired IPGs in the last three years were slightly less likely to feel that communication skills were a barrier for IPGs. Among those who had recently hired an IPG, 58% felt that written English/French were barriers, compared to 63% of those employers who had not recently hired an IPG. Similarly, 63% of employers who had hired IPGs said spoken English/French was a barrier, compared to 71% of those who had not. Employers who had recently hired IPGs were also less likely to see barriers for IPGs in communicating effectively with patients/clients (62% versus 72%), and in communicating effectively with other pharmacy staff (52% versus 60%). Communication barriers were also identified in interviews with bridging and support program providers. Some felt that IPGs may overestimate their communication skills. This may, in part, be a result of IPGs passing standardized fluency tests, but still demonstrating some weaknesses in communication. A prerequisite for licensure as a pharmacist in Canada is a demonstrated fluency in English or French. However, fluency is demonstrated through the use of standardized tests (Test of English as a Foreign Language, International English Language Testing System), and these tests do not indicate the level of proficiency in pharmacy-related terminology, profession-specific language, or socio-linguistic communication skills. Pharmacists rely almost exclusively on speaking, listening, reading and writing in order to gather information on which to base their patient care. Standardized tests may not measure the ability to undertake these important functions in pharmacy practice.23 23. Austin, Z., Rocchi Dean, M. Bridging education for foreign-trained professionals: the International Pharmacy Graduate (IPG) Program in Canada. Teaching in Higher Education. Jan 2006;11(1):19-32.

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© 2008 Canadian Pharmacists Association

Section 2: Findings

Figure 2—30 Employer vs. IPG Perceptions of the Barriers to IPGs’ Success in the Canadian Pharmacy Workforce: Proportion Stating Each Factor is a Barrier 32%

Financial burden of licensing/registration process

44%

Length of time required for licensing/ registration process

30% 41%

Lack of resources to assist in preparing for licensing/registration exams

25%

Lack of practical experience working in a Canadian pharmacy 14%

25%

Provincial differences in licensing/registration requirements specific to IPGs that limit labour mobility

Employer IPG

22% 24%

Lack of profession-specific technical and procedural knowledge

28% 20%

Lack of understanding of the Canadian models of pharmacy practice

20%

Lack of understanding of the Canadian health care system

40%

34% 19%

Cultural differences between Canada and the IPG’s country of origin

35%

17%

Lack of proficiency in applying clinical knowledge in a Canadian setting

35%

15%

Lack of proficiency in communicating effectively with patients or clients

67%

13%

Lack of accurate information regarding licensing/registration process

12%

21%

66%

Lack of proficiency in spoken English or French

12%

Lack of proficiency in written English or French

Lack of drug and therapeutic knowledge

43%

33%

Lack of information about how to find pharmacist employment in Canada

Lack of proficiency in communicating effectively with other pharamcy staff/health care providers

35%

60%

11%

55%

9%

7%

23%

0% 10% 20% 30% 40% 50% 60% 70% 80% Source: Employer Survey Q5, IPG Survey Q24

Integration of International Pharmacy Graduates into the Canadian Pharmacy Workforce: Barriers and Facilitators

45

Section 2: Findings

Some employers in focus groups felt that communication barriers related to writing in English were not especially significant factors, as these could be overcome over time, and that pharmacists do not generally use written English on the job. In some instances employers prioritized the pharmacy skills of the IPG over current communication skills. As one employer stated, “Having someone who can do the job is better than having someone that can ‘talk the talk.’” Cultural Differences that Impact Pharmacy Practice The role of the pharmacist in Canada has undergone significant change over the past two decades. Increasingly, pharmacists are responsible for providing disease and drug information to patients and other health care providers, and monitoring and follow-up of drug therapy. This practice evolution has not occurred in some countries, where pharmacy has stayed closer to its traditional role of primarily dispensing drugs and medicines. This evolution, and differences in health care systems generally, has meant that pharmacy practice in Canada can be very different than in other countries. Pharmacists in other countries may have different roles and expectations, particularly in terms of their roles in relation to physicians and patients. As a result, IPGs may suffer from “double shock,” which is “the need to simultaneously adapt to new cultures at both the personal and professional levels”.24 Over one-third (35%) of employers felt that cultural differences between Canada and IPGs’ country of origin acted as a barrier to IPG success. Furthermore, 40% of employers felt that IPGs’ lack of understanding of Canadian models of pharmacy practice was a barrier, and 35% of employers felt that a lack of proficiency in applying clinical knowledge in a Canadian setting was a barrier. Finally, 34% of employers felt that a lack of understanding of the Canadian health care system was a barrier to IPG success. These barriers were also identified in employer focus groups, particularly as they related to IPGs’ lack of familiarity with the Canadian health care system. Sometimes communication challenges and cultural differences overlap. Some key informants and bridging/support stakeholders noted in interviews that IPGs can face challenges in relation to Canadian gender roles and communicating with other health care providers. For example, it was noted that some female IPGs from more traditional cultures are unaccustomed to communicating with male patients/clients. Similarly, some IPGs are more accustomed to working in more hierarchical, and less team-based, work environments, and struggle with Canadian workplace norms. Facilitators of IPG Success IPGs were asked how effective they felt available information and supports were in helping them to become pharmacists in Canada. As shown in Figure 2-31, IPGs found a variety of supports and information to be useful. In particular, IPGs felt that “information about the process of becoming licensed/registered to practise as a pharmacist” and structured practical training were effective (65% and 63%). Information and services provided by the PEBC (58%) and bridging programs (55%) were also identified as effective. Among those who had completed a bridging program, 74% rated the program as effective. 24. Austin, Z. Mentorship and mitigation of culture shock: foreign trained pharmacists in Canada. Mentoring and Tutoring. April 2005;13(1):133-49.

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© 2008 Canadian Pharmacists Association

Section 2: Findings

Figure 2—31 IPGs’ Perceptions of Effectiveness of Facilitators of Success in Working as a Pharmacist in Canada Information about the process of becoming licensed/registered to practise as a pharmacist in Canada

65%

Structured practical training

21%

63%

Information and services provided by the Pharmacy Examining Board of Canada (PEBC)

18%

58%

55%

Available English and/or French language training

53%

Resources to help prepare for examinations

53%

Practice opportunities provided by employers

53%

Information and services provided by the Provincial Regulatory Authorities

52%

23%

Mentoring opportunities

51%

23%

IPG communities or professional networks Support programs available for immigrants (not necessarily designed for IPGs) Other (e.g., information/support from peers and family members, financial assistance with cost of education/other expenses)

19%

23%

22%

23%

24%

20%

27%

17%

47%

36%

19%

22%

Bridging programs for IPGs

Effective Neutral Not effective

14%

21%

21%

81%

30%

25%

26%

32%

43%

4%

15%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Source: IPG Survey Q25 Percentages were calculated excluding “Don’t know” responses.

Other types of supports or information that were effective were also provided by surveyed IPGs, and most often included information/supports from peers and family members, and financial assistance for the cost of education/other expenses. Employers were also asked to rate the effectiveness of supports and information in helping IPGs to become pharmacists in Canada. While many employers did not have an opinion on the effectiveness of the supports, 69% of those who did rated structured practical training as effective. Bridging programs for IPGs and practice opportunities provided by employers were also rated effective by 65% and 64% of employers, respectively. Integration of International Pharmacy Graduates into the Canadian Pharmacy Workforce: Barriers and Facilitators

47

Section 2: Findings

Figure 2—32 Employers’ Perceptions of the Effectiveness of Different Types of Facilitators in Assisting IPGs in Successfully Becoming Pharmacists in Canada

Structured practical training

69%

Bridging programs for IPGs

19%

65%

12%

23%

13%

Practice opportunities provided by employers

64%

23%

13%

Available English and/or French language training

63%

24%

13%

Effective Neutral Not effective

Mentoring opportunities

62%

24%

14%

Preparatory resources for examinations

61%

26%

13%

Information about the process of becoming licensed/registered to practise as a pharmacist in Canada

61%

26%

13%

Information and services provided by the Pharmacy Examining Board of Canada (PEBC)

60%

Information and services provided by the Provincial Regulatory Authorities Available support programs for immigrants (not necessarily designed for IPGs)

57%

51%

IPG communities or professional networks

48%

Other

33%

25%

16%

25%

17%

30%

35%

4%

19%

17%

63%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% n=315 Source: Employer Survey Q6 Percentage calculated excluding “I don’t know” response

The availability of supports specifically for IPGs within the workplace is fairly limited. For those IPG respondents who had worked as a pharmacist in Canada, only 23% reported that the pharmacy, company, or organization that they worked for offered any supports, services or programs specifically designed for IPGs. These supports included practical training programs to help with licensure process/to gain experience in a Canadian pharmacy (42%) and financial assistance with the cost of licensure/registration, education and/or living expenses (35%). The majority of IPG respondents (60%) feel that there is a need for employers to offer specialized support programs specifically designed for IPGs. Forty-one per cent of respondents reported that “more opportunities for practical training” were needed. At 16%, “more employment opportunities” was the next most common response, followed by “financial assistance with education/other expenses while pursuing licensure” (15%). 48

© 2008 Canadian Pharmacists Association

Section 3: Key Findings

Section 3: Key Findings Settling In Canada While IPGs come from many different areas and backgrounds, IPGs are typically from Southeast Asia or the Middle East, have an undergraduate pharmacy degree as their highest level of education, and have experience working as a pharmacist The majority (74%) of IPGs come to Canada from Southeast Asia (typically India, Pakistan, the Philippines) or the Middle East (typically Egypt, Iran, Jordan). Generally, IPGs have completed an undergraduate pharmacy program as their highest level of education, and 85% have experience working as a pharmacist before coming to Canada. There is no single source of information that outlines the complete process and requirements to becoming licensed/registered to practise as a pharmacist in Canada IPGs have indicated that before settling in Canada they are able to obtain useful information from the PEBC, the provincial pharmacy regulatory authorities, as well as friends, family, and other sources. However, both IPGs and employers indicate that, while individual sources of effective information exist, there is no single source which outlines all the requirements and provincial differences in the licensure process. IPGs often feel that they do not have all the necessary information prior to making their decision to come to Canada, and may be making settlement decisions based on incomplete information or incorrect assumptions. For example, while many IPGs feel that they should settle in larger cities where there are likely to be more job opportunities, evidence suggests job opportunities might be more plentiful in smaller cities or towns. Most IPGs expect they will eventually work as pharmacists in Canada Over three-quarters (78%) of IPGs indicated that when they settled in Canada they expected they would, at some point, work as a pharmacist in Canada. While some expected that they may have to work as pharmacy technicians or, in Quebec, return to university to take some schooling, most planned to become pharmacists.

Licensing/Registering to Practise as a Pharmacist in Canada Pass rates for IPGs in each of the PEBC examinations are low During the years of 2002-2006, combining all examination sittings, the IPG pass rate was 59% for the Evaluating Exam, 48% for the Qualifying Examination Part I, and 45% for the Qualifying Examination Part II (the OSCE). These pass rates are significantly lower than those of Canadian graduates. The pass rate for IPGs on their first attempt at each of these exams is even lower, with 43% of IPGs passing the Qualifying Exam Part I and only 39% of IPGs passing the Qualifying Exam Part II on their first attempt. A significant proportion of IPGs are often taking more than one attempt at PEBC examinations While only a quarter (26%) of unique IPGs generally make more than one attempt at the Evaluating Exam, almost one-half of unique IPGs are taking more than one attempt at the Qualifying Examination Part I (46%) and Part II (48%). By comparison only a small proportion of Canadian graduates (less than 10%) are required to take more than one attempt at either portion of the Qualifying Examination. Integration of International Pharmacy Graduates into the Canadian Pharmacy Workforce: Barriers and Facilitators

49

Section 3: Key Findings

IPGs are finding the licensure process to be very time-consuming While about one-quarter (24%) of IPGs completed their licensure in one year or less, 58% required two years or more. The average amount of time to complete licensure was 26 months, and the median time was 24 months. 41% of IPGs also report that the time required to complete the licensure process was a major barrier to their eventual success in practicing pharmacy in Canada. IPGs rated the Qualifying Examination Part II (the OSCE) as the most difficult step in the licensing process IPGs felt that the PEBC Qualifying Examination, particularly the OSCE, was the most difficult part of the licensing process. About three-quarters of surveyed IPGs felt that the Qualifying Examination Part I (74%) and Qualifying Examination Part II (77%) were “difficult” or “very difficult”, with 19% rating Qualifying Examination Part I and 28% rating Qualifying Examination Part II as “very difficult”, respectively. The Evaluating Examination was also rated as “difficult” or “very difficult” by a majority (58%) of IPGs. Finding a practical training position was rated as “very difficult” by 26% of IPGs, and “difficult” by 28% of IPGs. Both IPGs and employers feel that additional programs or supports are needed to support IPGs on the path to licensure Most IPGs and most employers feel that additional supports are needed to support IPGs on the path to licensure. Employers most strongly favour language and communication skills support, while IPGs suggest more practical training opportunities. However, employers also suggest practical or clinical training as a key additional support.

Bridging Programs Bridging programs and courses are generally seen as beneficial to the IPGs who participate in them Bridging programs are formal, post-degree programs of study designed to address gaps between an IPG’s education or experience and standards of pharmacy practice in Canada. Nine identified and documented bridging programs and courses are available to assist IPGs in becoming licensed and practising pharmacists in Canada. These programs range from intensive university-based programs in Toronto and Vancouver to short examination preparatory or pharmacy communication programs. IPGs feel they benefit from bridging programs in a variety of ways, including being informed about pharmaceutical care, applied therapeutics, and the roles and responsibilities of pharmacists in Canada. Not all IPGs have access to, or are making use of, the existing supports Sixty per cent of IPGs surveyed indicated that they had never participated in an IPG bridging program and have no plans to do so in the future. Bridging programs are a relatively new phenomenon in Canada, and there are many areas of the country where IPGs do not have access to bridging programs and courses. Even those IPGs who are in close proximity to a bridging or support program do not always participate in the programs, however. The majority of IPGs feel they do not need to take the bridging or support programs.

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Working in Canada Despite the challenges of licensure and settling in Canada, IPGs are generally finding work in pharmacy The majority (70%) of IPG survey respondents indicated that they have at some point worked as a pharmacist in Canada. Similarly, 44% of surveyed employers indicated that they have hired at least one IPG during the last three years. IPGs are most often made an offer of employment while they are permanent residents or landed immigrants. Employers are making offers of employment to IPGs at various stages of the licensure process, most commonly after the Evaluating Examination, or after the IPG has already worked for up to five years in Canada as a licensed pharmacist. Interestingly, a sizeable proportion of employers indicated that they are not aware of the immigration status (25%) or the stage in the licensure process (12%) of IPGs that they have hired. Many IPGs are finding work as pharmacy technicians in Canada Forty six per cent of IPG survey respondents indicated that they had at one time worked as a pharmacy technician in Canada. This often occurs either as an interim step in the process of becoming a pharmacist, or because of difficulties in becoming licensed or finding employment as a pharmacist. Some IPGs however, feel they have become “trapped” in the position of pharmacy technician, and cannot afford the time and money required to become licensed to practice as a pharmacist. In some cases, working as a pharmacy technician is disappointing and frustrating for IPGs, who feel a sense of a loss, or diminishment of identity. While IPGs face many challenges to success in the Canadian pharmacy workforce, communication skills are seen by employers as a particularly severe barrier While IPGs identified the cost and time involved in the licensure process as the most significant barriers to their success, employers were most likely to identify barriers related to communication skills. About two-thirds (67%) of surveyed employers identified a lack of proficiency in communicating effectively with patients/clients and a lack of proficiency in spoken English/French (67%) as barriers to IPGs’ success. Furthermore, 55% of employers felt that a lack of proficiency in communicating effectively with other pharmacists was a barrier. IPGs do not generally believe that the English/French language fluency requirements of licensure are a major barrier to their success. The research suggests that communication can be a challenge for IPGs, however, particularly in relation to different cultural norms in communication and to pharmacy-specific language. Employers do not generally see particular advantages or disadvantages to hiring IPGs Overall, employers did not feel that there were particular advantages or disadvantages to employing IPGs. While some employers note the considerable experience that IPGs bring to the job, there is less recognition of the cultural advantages IPGs bring to practice.

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Research Appendices

Research Appendices Appendix A: Bibliography Agro Health Associates. OSCE Preparatory Course. Available from: http://www.agrohealth.com/courses.htm. Accessed September 2007. Alberta College of Pharmacists. Applicants who received their pharmacy degree outside of Canada. Available from: http://pharmacists.ab.ca/registration_licensure/pharmacists.aspx?id=4870. Accessed August 2007. Austin Z. Geographical migration, psychological adjustment, and re-formation of professional identity: the double-culture shock experience of international pharmacy graduates in Ontario (Canada). International Migration Review, 2003. Austin Z, Rocchi Dean M. Bridging education for foreign-trained professionals: the international pharmacy graduate (IPG) program in Canada. Teaching in Higher Education. Jan. 2006;11(1):19-32. Austin Z. Mentorship and mitigation of culture shock: foreign-trained pharmacists in Canada. Mentoring and Tutoring: Partnership in Learning. April 2005;13(1):133-49. Austin Z. Continuous professional development and foreign-trained health care professionals: Results of an educational needs assessment of international pharmacy graduates in Ontario (Canada). Journal of Social and Administrative Pharmacy. 2003; 20(6):143-51. Austin Z, Rocchi Dean M. Development of a curriculum for foreign-trained pharmacists seeking licensure in Canada. Pharmacy Education. 2004; 14(9): 1-9. Austin Z, Rocchi Dean M. Bridging education in pharmacy: the international pharmacy graduate program in Ontario, Canada. American Journal of Pharmaceutical Education. 2004; 68(5):1-11. Austin Z, Galli M. Assessing communicative competency of international pharmacy graduates in Ontario, Canada. Journal of Social and Administrative Pharmacy. 2003;20(6):225-31. Austin Z, Galli M, Diamantouros A. Development of a prior learning assessment for pharmacists seeking licensure in Canada. Pharmacy Education. June 2003;3(2):87-96. Blackburn & Associates. An environmental scan of pharmacy technicians (roles and responsibilities, education and accreditation, and certification). Moving Forward: Pharmacy Human Resources for the Future, October 2006. Bredin Institute. International pharmacy bridging program. Available from: http://www.bredin.ab.ca/TrainingPrograms/International%20Pharmacy%20Bridging%20Program/default.aspx. Accessed September 2007. British Columbia College of Pharmacists. Guide to becoming a pharmacist in British Columbia. Available from: http://www.bcpharmacists.org/registration/. Accessed August 2007 Gaither CA., et al. Should I stay or should I go? The influence of individual and organizational factors on pharmacists’ future work plans. Journal of American Pharmacy Association. March/April 2007; 47(2):165-73. Government of Canada. The Canadian Immigration Integration Project. Available from: http://ciip.accc.ca/default.aspx?DN=782,32,Documents. Accessed September 2007. Hao X, Wuliji T. Global Pharmacy Workforce and Migration Report. International Pharmaceutical Federation, 2006. Humphrey GE, Quinones AC. Addressing the pharmacist shortage through a cooperative internship program for foreign pharmacy graduates. Journal of American Pharmacy Association. March/April 2007; 47(2):191-96.

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Metropolitan Immigrant Settlement Association. Internationally Educated Professionals. Available from: http://www.misa.ns.ca/iep.php. Accessed September 2007. National Association of Pharmacy Regulatory Authorities. Making the move: The mutual recognition agreement for pharmacists in Canada. Rogers Media — Healthcare & Financial Publishing, February 2002. National Association of Pharmacy Regulatory Authorities. National Statistics. Available from: http://www.napra.org/docs/0/86/363.asp. Accessed August 2007. Ontario College of Pharmacists. Pharmacy graduates from other Nations: e-factsheet. Available from: http://www.newontariopharmacist.com. Accessed August 2007. Ordre des pharmaciens du Quebec. Admission à la pratique: Diplomés hors du Québec. Available from: http://www.opq.org/fr/admission/diplomes_hors_quebec. Accessed August 2007. Pugsley J. Recognition of the international experience and credentials of immigrants. The Pharmacy Examining Board of Canada, May 5, 2005. Registered Nurses Professional Development Centre. Orientation to the Canadian health care system. Available from: http://www.cdha.nshealth.ca. Accessed September 2007. Tessier A. Prescription for learning: Communication skills for the practice of pharmacy. Emerald Education Services, March 31, 2004. University of British Columbia. Canadian Pharmacy Practice Programme. Available from: http://www.pharmacy.ubc.ca/cppd/programs/CP3_Program.html. Accessed September 2007. University of Toronto. International Pharmacy Graduate Program. Available from: http://www.ipgcanada.ca/. Accessed September 2007. Vision Research. The pharmacy technician workforce in Canada: Roles, demographics and attitudes (part I), responses to National Survey of Pharmacy Technicians and Assistants. Canadian Pharmacists Association, March 2007. Vision Research. The pharmacy technician workforce in Canada: Roles, demographics and attitudes (part II), responses to National Survey of Pharmacists (Owners and Managers). Canadian Pharmacists Association, March 2007.

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Appendix B: Survey Questionnaires

SURVEY OF INTERNATIONAL PHARMACY GRADUATES (IPGS) The pharmacy profession would like to understand the challenges facing international pharmacy graduates (IPGs) who want to work in Canada. We are doing this survey to collect information from people living in Canada who received their undergraduate pharmacy degree in another country. This research will help us find ways to deal with the problems many IPGs face. This survey is part of a large research project, called Moving Forward: Pharmacy Human Resources for the Future. The project is led by the Canadian Pharmacists Association and its partners. It is funded by the Government of Canada’s Foreign Credential Recognition program. The Moving Forward project has hired R. A. Malatest and Associates Ltd., a private research firm, to carry out this survey and other research. The research firm will keep all the survey information private and confidential. Individuals will not be identified or linked to their responses. Thank you for taking part in this important research. If you prefer to complete the survey online, please go to the following Web site address: http://survey.malatest.com/PHARMACIST_IPG Your password for the online survey is the number in the bottom right-hand corner of this survey.

Objective of the Survey:

To obtain the perspectives of international pharmacy graduates (IPGs) on the issues and challenges they face in the process of: • deciding to become a pharmacist in Canada, • getting licensed/registered to practice in Canada, and • integrating into the Canadian pharmacy workforce.

Who will participate in the survey?

The study will include the following groups of IPGs: (1) people who are working as pharmacists, (2) people not employed as pharmacists, and (3) people who are in the process of becoming licensed or registered.

Confidentiality:

Information provided by survey respondents will be kept confidential. Results will be provided to the Canadian Pharmacists Association in summarized form only, without identifying individual respondents.

Do you have questions?

If you have any questions about the survey, or the research in general, please contact Sarah Leger of R.A. Malatest and Associates Ltd., at (toll-free) 1-888-689-1847 or [email protected]

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CONTACT INFORMATION Name: H Dr.

H Mr.

H Mrs.

H Ms. H Miss.

(First) __________________________________________ (Last) __________________________________________________ Telephone: (_______) ____________________________ Fax: (________)__________________________________________ E-mail: ________________________________________ @______________________________________________________

BEFORE SETTLING IN CANADA The following questions ask about your experiences before settling in Canada. 1.

2.

Did you complete your undergraduate pharmacy education in a country other than Canada? H

No

ª If NO, END survey

H

Yes

ª If YES, CONTINUE survey

In what part(s) of the world did you complete your undergraduate pharmacy education? [Check ALL that apply.] H The United States of America

H South America

H Mexico

H China

H The United Kingdom

H South-East Asia (e.g., the Philippines, India, Pakistan, Bangladesh)

H Europe (not including the United Kingdom) H Russia and Commonwealth of Independent States (Belarus, Georgia, etc.)

H Other Asia (e.g., Japan, Korea) H Middle East (e.g., Egypt, Israel, Iran)

H Australia

H Other (please specify): ____________________

H Africa

H Don’t Know / Unsure

H The Caribbean (e.g., Trinidad and Tobago, Jamaica, West Indies)

3a. What pharmacy degree(s) did you complete outside of Canada? [Check ALL that apply.] H

Bachelor’s degree

H

Master’s degree

H

PhD

H

Pharm. D.

H

Other, please specify: ____________________

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3b. In what year did you complete your undergraduate pharmacy degree? ________________ 3c. What was the language of instruction? H

English

H

French

H

Other, please specify: _______________

4a. Before settling in Canada, did you practise as a pharmacist in another country? H

No

ª If NO, GO TO Question #5

H

Yes ª If YES, for how many years? ________________

4b. If YES, please indicate your primary area of practice before settling in Canada:

5.

6.

H

Hospital

H

Pharmaceutical industry

H

Community

H

Government

H

Military

H

Academic institution

Other

Before settling in Canada, did you expect that you would at some time work as a pharmacist in Canada? H

No

ª If NO, GO TO Question #27

H

Yes

ª If YES, CONTINUE survey

How effective were the following sources of information in helping you make your decision to practise as a licensed/registered pharmacist in Canada?

Canadian embassy or consulate Friends or peers living in Canada Friends or peers living outside of Canada Family living in Canada Family living outside of Canada Pharmacy recruiter Pharmacy employer Pharmacy Examining Board of Canada (PEBC) Provincial Pharmacy Licensing Authority / Regulatory Body Canadian Pharmacists Association (CPhA) Provincial government(s) of Canada Federal government of Canada (e.g., Citizenship and Immigration Canada, others) Other, please specify:

56

H

Did not consult

Not very Effective

Somewhat Effective

Effective

Very Effective

Don’t Know

J J J J J J J J J J J J J

J J J J J J J J J J J J J

J J J J J J J J J J J J J

J J J J J J J J J J J J J

J J J J J J J J J J J J J

J J J J J J J J J J J J J

© 2008 Canadian Pharmacists Association

Research Appendices

LICENSING AND REGISTRATION The next questions are about the process of becoming licensed/registered to practise as a pharmacist in Canada. The “licensing/registration process” refers to any of the steps required to become licensed or registered to practise as a pharmacist in your province. 7.

Do you have your license/registration to practise as a pharmacist in a Canadian province? H

No

ª If NO, GO TO Question #9

H

Yes

ª If YES, CONTINUE survey

8a. [If you DO HAVE your license/ registration to practise in a province of Canada]: What year did you get your license/registration to practise in a province of Canada? _____________ 8b.

In which province or territory did you get your first license/registration? H

British Columbia

H

New Brunswick

H

Alberta

H

Prince Edward Island

H

Saskatchewan

H

Newfoundland & Labrador

H

Manitoba

H

Yukon

H

Ontario

H

Northwest Territories

H

Quebec

H

Nunavut

H

Nova Scotia

8c. How long did the licensing/registration process take? Please estimate the amount of time between when you first had your documents evaluated by the Pharmacy Examining Board of Canada (PEBC) and when you became licensed/registered to practise as a pharmacist in a Canadian province. Licensing/registration process took ______________ months 8d. Are you trying to get licensed/registered in another province? H

YES, in the province of ________________________________

H

NO

[NOW GO TO Question #11]

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9.

[If you DO NOT HAVE your license / registration to practise in a province of Canada] Will you try to get your license/registration? [Check ONE only] H

I am not currently trying to get licensed/registered and have no intention of getting licensed/registered. . . . . . . . . . . . . . . . . . . . .

ª GO TO Question #12a

H

I am not currently trying to get licensed/registered but intend to try in the future . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ª CONTINUE Survey

H

I am currently trying to get licensed/registered

ª CONTINUE Survey

..............

10a. [If you ARE TRYING OR WILL TRY to get your license / registration to practise in a province of Canada] In what province are/will you try to get licensed/registered? ____________ 10b. What steps of the licensing/registration process have you successfully completed? [Check ALL that apply.] H Have not completed any licensing/registration requirements H Completed Pharmacy Examining Board of Canada (PEBC) Evaluating Examination . . . . . . . . . . . . . . . . . . . . . . .

ª # of exam attempts? _______

H Completed Part I of the PEBC Qualifying Examination (Multiple Choice Questionnaire) . . . . . . . . . . . . . . . . . .

ª # of exam attempts? _______

H Completed Part II of the PEBC Qualifying Examination (Objective Structured Clinical Examination) . . . . . . . . . .

ª # of exam attempts? _______

H Completed language fluency requirements H Completed in-service or practical training (as a student or intern etc.) H Completed provincial jurisprudence examination (exam on legal information) H Completed other province-specific licensing/registration requirements (e.g. Ontario IPG Program requirements, Quebec Diploma Equivalency education) H Submitted application for license/registration H Don’t Know / Unsure

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11. In your opinion, how easy or difficult were each of the following steps of the licensing/registration process that you have undertaken? Very Easy

Easy

Difficult

Very Difficult

Don’t Know / Have not Taken

c) The PEBC Qualifying Exam Part I (Multiple Choice Questionnaire)

J J J

J J J

J J J

J J J

J J J

d) The PEBC Qualifying Exam Part II (Objective Structured Clinical Examination)

J

J

J

J

J

e) Meeting English or French fluency requirements

J J J

J J J

J J J

J J J

J J J

h) Meeting other educational requirements in your province (e.g., Ontario IPG program requirements, Quebec diploma

J

J

J

J

J

i) Getting licensed/registered in your province

J

J

J

J

J

a) Having documents examined by PEBC b) The PEBC Evaluating Exam

f) Finding a practical training position g) Provincial jurisprudence examination

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BRIDGING PROGRAMS Bridging programs are available to help IPGs become pharmacists in Canada. In this survey, “bridging program” means a formal, post-degree program of study designed to address gaps between an IPG’s education or experience and standards of pharmacy practice in Canada. Please note that a bridging program is not a post-graduate degree program, such as a Pharm D or Master’s program. Bridging programs can include: • • • •

University-based programs Community-college based programs Private vocational college-based programs Programs offered by private consultants and others.

12a. Are you currently aware of any bridging programs available for IPGs in Canada? H Yes H No H Don’t Know / Unsure 12b. [If YES] What bridging programs for IPGs are you aware of? [Please LIST]

____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________

13a. Do you feel that there is a need for additional bridging programs or other programs to support IPGs while they are becoming licensed/registered as Canadian pharmacists? H Yes H No H Don’t Know / Unsure 13b. [If YES] What additional bridging programs or other supports do you feel are needed for IPGs?

____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________

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14. Please describe your experience with Canadian bridging programs designed for IPGs. [Check ONLY ONE.] H Never participated in an IPG bridging program and have no plans to register for one in the future. H Registered for, but not yet started, an IPG bridging program. H Currently participating in an IPG bridging program. H Participated in an IPG program in the past, but did not complete all the requirements. H Successfully completed an IPG bridging program. H Don’t Know / Unsure

[If you HAVE NOT participated in an IPG bridging program, GO TO Question #16.] [If you HAVE participated in an IPG bridging program CONTINUE Survey]

15a. If you HAVE participated in or registered for an IPG bridging program, which IPG bridging program was it?

____________________________________________________________________________ 15b. What was your main reason for taking the IPG bridging program? [Check ONLY ONE.] H To help prepare for the PEBC examinations H To meet provincial licensing/registration requirements H To improve your pharmacy skills and knowledge H To understand the roles and responsibilities of being a pharmacist in Canada H Other, please specify: ______________________________________________ H Don’t Know / Unsure

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15c. Please rate the effectiveness of the following aspects of the IPG bridging program you participated in. Not Very Effective

Somewhat Effective

Effective

Very Effective

Don’t Know / Not Applicable

a) Information you received on the roles and responsibilities of pharmacists in Canada

J

J

J

J

J

b) Information you received on technical and procedural knowledge required by pharmacists in Canada

J

J

J

J

J

c) Information you received about the licensing/registration process and requirements

J

J

J

J

J

d) Information you received about workplace behaviour and expectations in Canadian pharmacies

J

J

J

J

J

e) Information you received about pharmaceutical care (diseases and therapeutics)

J

J

J

J

J

f) Information your received about applied therapeutics

J J J

J J J

J J J

J J J

J J J

i) Ability to interact with established practitioners and pharmacists

J

J

J

J

J

j) Assistance in getting your pharmacist licence/registration in Canada

J

J

J

J

J

g) Ability to meet your peers h) Respect for your prior experience and education

[NOW GO TO Question #17]

16. If you have NOT participated in or registered for an IPG bridging program, why not? [Check ALL that apply.]

62

H

Did not need it

H

IPG bridging program seemed too difficult

H

Not aware of any IPG bridging programs

H

H

No IPG bridging programs in my area

Could not take the IPG bridging program because of family commitments

H

Did not have the money to take an IPG bridging program

H

IPG bridging program was too long / involved too much time

H

Don’t Know / Unsure

H

Did not meet all of the admission requirements of the IPG bridging program

© 2008 Canadian Pharmacists Association

Research Appendices

EMPLOYMENT IN CANADA 17. What is your current employment status? [Check ONLY ONE.] H Employed as a pharmacist H Employed as a pharmacy intern H Employed as a pharmacy student H Employed as a pharmacy technician H Volunteering in a pharmacy H Currently employed but not in a field related to pharmacy H Currently unemployed but looking for work in a pharmacy H Currently unemployed but looking for work in a field unrelated to pharmacy H Currently unemployed and not looking for work H Retired H Other

18. Since arriving in Canada, have you ever tried to find work in Canada as: a. A pharmacist

H Yes

H No

b. A pharmacy technician

H Yes

H No

19. Since arriving in Canada, have you ever worked in Canada as: a. A pharmacist

H Yes

H No

b. A pharmacy technician

H Yes

H No

[Questions #20 to #23 are only for people who HAVE WORKED as a pharmacist in Canada.] [If you have NEVER worked as a pharmacist in Canada, GO TO Question #24.]

20. [If you HAVE WORKED as a pharmacist in Canada]: Did you have to move away from the city or province where you first settled to get work as a pharmacist in a pharmacy? H Yes H No H Don’t Know / Unsure

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21a. [If you HAVE WORKED as a pharmacist in Canada]: Please tell us the types of pharmacies you have worked in as a pharmacist in Canada: [Check ALL that apply.] H Health care institution (hospital, long term care)

H Independent community pharmacy

H Chain, banner or franchise pharmacy

H Other

21b. Please tell us the type of pharmacy where you worked the longest as a pharmacist in Canada: [Check ONLY ONE.] H Health care institution (hospital, long term care)

H Independent community pharmacy

H Chain, banner or franchise pharmacy

H Other

22. [If you HAVE WORKED as a pharmacist in Canada]: How big was the community where this pharmacy is/was located? H Rural area (less than 5,000 people) H Urban centre of 5,000 to 100,000 people

H Urban centre of 100,000 to less than to less than 500,000 people H Urban centre of 500,000 people and over

23a. [If you HAVE WORKED as a pharmacist in Canada]: Does/did this pharmacy, company or organization offer any supports, services or programs that are specifically designed for IPGs? H Yes H No H Don’t Know / Unsure

23b. IF YES, what did it offer?

____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________

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24. To what extent do you feel the following things may have acted as barriers to your success in working as a pharmacist in Canada? Circle a number from 1 to 5, where ‘1’ means ‘Not a barrier at all’ and ‘5’ means ‘A very significant barrier’? Not a barrier at all

A very significant barrier

Don’t know

a) Lack of understanding of Canadian health care system

1

2

3

4

5

H

b) Lack of understanding of Canadian models of pharmacy practice

1

2

3

4

5

H

c) Lack of proficiency in applying clinical knowledge in a Canadian setting

1

2

3

4

5

H

d) Lack of drug and therapeutic knowledge

1

2

3

4

5

H

e) Lack of profession-specific technical and procedural knowledge (e.g., computer software)

1

2

3

4

5

H

f) Lack of proficiency in written English or French

1

2

3

4

5

H

g) Lack of proficiency in spoken English or French

1

2

3

4

5

H

h) Lack of proficiency in communicating effectively with patients/clients

1

2

3

4

5

H

i) Lack of proficiency in communicating effectively with other pharmacy staff and other health care providers

1

2

3

4

5

H

j) Lack of practical experience working in a Canadian pharmacy

1

2

3

4

5

H

k) Lack of accurate information regarding licensing/registration process

1

2

3

4

5

H

l) Lack of resources to assist in preparing for licensing/registration exams

1

2

3

4

5

H

m) Length of time required for licensing/registration process

1

2

3

4

5

H

n) Financial cost of licensing/registration process

1

2

3

4

5

H

o) Lack of information about how to find work as a pharmacist in Canada

1

2

3

4

5

H

p) Provincial differences in licensing/registration requirements specific to IPGs that make it difficult to move from one province to another

1

2

3

4

5

H

q) Cultural differences between Canada and your country of origin

1

2

3

4

5

H

24.r) Please tell us about other barriers, if any:

____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________

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25. In your opinion, how effective are the items listed below in helping you become a pharmacist in Canada? Circle a number from 1 to 5, where ‘1’ means ‘Not effective at all” and ‘5’ means ‘Very effective’? Not effective at all

Very effective

Don’t know

a) Information about the process of becoming licensed/registered to practise as a pharmacist in Canada

1

2

3

4

5

H

b) Bridging programs for IPGs

1

2

3

4

5

H

c) Resources to help prepare for examinations

1

2

3

4

5

H

d) Support programs available for immigrants (not necessarily designed for IPGs)

1

2

3

4

5

H

e) Practice opportunities provided by employers

1

2

3

4

5

H

f) Structured practical training

1

2

3

4

5

H

g) IPG communities or professional networks

1

2

3

4

5

H

h) Mentoring opportunities

1

2

3

4

5

H

i) Available English- and/or French-language training

1

2

3

4

5

H

j) Information and services provided by the Pharmacy Examining Board of Canada (PEBC)

1

2

3

4

5

H

k) Information and services provided by the Provincial Regulatory Authorities

1

2

3

4

5

H

l) Other (please specify)

1

2

3

4

5

H

26a. Do you feel there is a need for employers to offer any kind of specialized support programs specifically designed for IPGs? H Yes H No H Don’t Know / Unsure 26b. If YES, what is needed?

____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________

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GENERAL INFORMATION 27. How old are you? H 18 to 24 years of age

H 45 to 54 years of age

H 25 to 34 years of age

H 55 to 64 years of age

H 35 to 44 years of age

H 65 years of age or older

28.Gender: H Male H Female

29. In which province or territory do you currently live? H British Columbia

H Nova Scotia

H Alberta

H Prince Edward Island

H Saskatchewan

H Newfoundland & Labrador

H Manitoba

H Yukon

H Ontario

H Northwest Territories

H Quebec

H Nunavut

H New Brunswick

H Do not live in Canada

30a. What is your current immigration or residency status? H Not yet applied for entry to Canada H In Canada under a temporary work permit H In Canada under student visa H In Canada under a visitors visa H Permanent resident / landed immigrant H Application for permanent residency approved, but not yet resident in Canada H Canadian citizen H Other immigration status (for example, refugee) H Don’t Know / Unsure 30b. How many years have you been living in Canada? (If less than one year, please put “0”.) __________________ years

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31. Is your first language English, French or another language? H English H French H Other, please specify: _______________

32. Would you be willing to participate in a focus group or one-on-one interview to discuss the issues outlined in this survey? H Yes H No [NOTE: You can earn Continuing Education Credits by participating in a focus group]

Please return your completed survey in the enclosed postage-paid envelope or by one of the following methods: Toll-free fax: 1-866-288-1278 Toll-free telephone: 1-877-688-5051

Mail:

R.A. Malatest & Associates Ltd. 400 – 294 Albert Street Ottawa, ON K1P 6E6

To complete online, please go to the following URL: http://survey.malatest.com/PHARMACIST_IPG Your password to access the online survey is the number located on the bottom right-hand corner of the first page of the survey. If you have any questions, please contact: R.A. Malatest & Associates Ltd. 400 – 294 Albert Street Ottawa, ON K1P 6E6 Toll-free telephone: 1-888-689-1847

THANK YOU FOR COMPLETING THIS IMPORTANT SURVEY

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Research Appendices

RESEARCH ON INTERNATIONAL PHARMACY GRADUATES SURVEY OF PHARMACY EMPLOYERS The pharmacy profession needs your help in collecting information to better prepare the pharmacy workforce for the health care needs of the future. The research is part of Moving Forward: Pharmacy Human Resources for the Future, a collaborative initiative led by the Canadian Pharmacists Association and its national pharmacy organization partners. This initiative was launched in 2005 and is funded by the Government of Canada’s Foreign Credential Recognition program. The Canadian Pharmacists Association (on behalf of the Moving Forward Initiative) has commissioned R.A. Malatest and Associates Ltd., a private research firm, to undertake research exploring the human resources issues and challenges surrounding the integration of international pharmacy graduates (IPGs) in the Canadian pharmacy workforce. The research includes a survey of pharmacy employers across Canada, to gain the broad range of employer perspectives from community, hospital, long-term care, and other types of pharmacies. Your pharmacy has been selected to participate in this national survey. This short confidential survey should be completed by the director, manager or owner of your pharmacy (this location only) or the most senior person responsible for human resources at your pharmacy (this location only). Thank you for your involvement in this important research. Objective of the Survey To obtain the perspectives of employers on issues and workplace challenges facing international pharmacy graduates in Canada. The study will include the perspectives of employers who employ international pharmacy graduates, as well as those who do not. Confidentiality Information provided by survey respondents will be kept confidential, and results will be provided to the Canadian Pharmacists Association in summarized form only, without identifying individual respondents. Questions If you have any questions about the survey, or the research in general, please contact Sarah Leger of R.A. Malatest and Associates Ltd., at (toll-free) 1-888-689-1847 or [email protected] CONTACT INFORMATION Name: H Dr.

H Mr.

H Mrs.

H Ms. H Miss.

(First) __________________________________________ (Last) __________________________________________________ Job Title: ______________________________________ Organization: ___________________________________________ Telephone: (_______) ____________________________ Fax: (________)__________________________________________ E-mail: ________________________________________ @______________________________________________________

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This survey is designed to obtain your perspectives on issues related to international pharmacy graduates (IPGs). For the purposes of this survey, an “international pharmacy graduate” is defined as anyone who obtained their undergraduate pharmacy education outside of Canada. If your pharmacy is part of a chain or has multiple locations, please frame your survey responses with respect to your (single) pharmacy location only.

1a.

How many IPGs and domestic pharmacy graduates has your pharmacy hired for each of the following positions during the past three years?

Please count any individuals hired by your pharmacy only once, and only for the position for which they were first hired.

International Pharmacy Graduates

Canadian Graduates

0

1–4

5–9

10–49

50+

Don’t know

0

1–4

5–9

10–49

50+

Don’t know

Full-time Registered/Licensed Pharmacist

J

J

J

J

J

J

J

J

J

J

J

J

Part-time Registered/Licensed Pharmacist

J

J

J

J

J

J

J

J

J

J

J

J

Casual/locum/relief Registered/Licensed Pharmacist

J

J

J

J

J

J

J

J

J

J

J

J

Intern*

J

J

J

J

J

J

J

J

J

J

J

J

Student*

J

J

J

J

J

J

J

J

J

J

J

J

Pharmacy Technician or Assistant

J

J

J

J

J

J

J

J

J

J

J

J

Volunteer

J

J

J

J

J

J

J

J

J

J

J

J

Hospital Resident

J

J

J

J

J

J

J

J

J

J

J

J

*Although the designations “intern” and “student” may vary according to province, an intern typically has a higher degree of autonomy regarding scope of practice and may work in an unsupervised capacity, usually with the condition that a pharmacist be physically present on the premises.

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1b.

How many IPGs does your pharmacy currently employ?

Number of IPGs currently employed as registered/licensed pharmacists: Number of IPGs currently employed as pharmacy technicians or assistants:

The following questions apply only to those survey respondents who have hired IPGs during the past three years. If no IPGs were hired during this period, please proceed to question #3. 2a. From what area(s) of the world did the IPGs hired within the last three years first obtain their undergraduate pharmacy education(s)? [CHECK ALL THAT APPLY.]  The United States of America

 South America

 Mexico

 China

 The United Kingdom

 South-East Asia (e.g., the Philippines, India, Pakistan, Bangladesh)

 Europe (not including the United Kingdom)  Russia and Commonwealth of Independent States (e.g. Belarus, Georgia)

 Other Asia (e.g., Japan, Korea)

 Australia

 Other (please specify): ____________________

 Africa

 Don’t Know / Unsure

 Middle East (e.g., Egypt, Israel, Iran)

 The Caribbean (e.g., Trinidad and Tobago, Jamaica, West Indies) 2b. What best describes the immigration or residency status of these IPGs when your pharmacy made the offer(s) of employment? [CHECK ALL THAT APPLY IF YOU HAVE HIRED ANY IPGs DURING PAST THREE YEARS.]  Not yet applied for entry to Canada  In Canada on visitor’s visa  In Canada under a temporary work permit  In Canada under student visa  Permanent resident / landed immigrant  Application for permanent residency approved, but not yet resident in Canada  Canadian citizen  Other immigration status (e.g. refugee)  Don’t Know / Unsure

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2c. At what step in the licensing/registration and practice process* were these IPGs when your pharmacy made the offer(s) of employment? *The “licensing/registration process” refers to any of the necessary steps IPGs must take to become licensed/registered to practise as a pharmacist in your province. This can include the Pharmacy Examining Board of Canada (PEBC) Evaluating Examination, the PEBC Qualifying Examinations, or any specific step or requirement as set out by your province’s regulatory authority such as structured practical training, language fluency, and jurisprudence examination. [CHECK ALL THAT APPLY IF YOU HAVE HIRED ANY IPGs DURING PAST 3 YEARS.]  Had not completed any licensing/registration requirements or examinations  Successfully completed the PEBC Evaluating Examination  Had completed part or all of an IPG bridging program*  Successfully completed Part I of the PEBC Qualifying Examination  Successfully completed Part II of the PEBC Qualifying Examination  Was in the process of fulfilling other provincial licensing/registration requirements (e.g. meeting designated language fluency, structured practical training, jurisprudence, Quebec Diploma equivalency)  Successfully received provincial licensure/registration to practice, but not yet practising  Had practised for 0-5 years as a registered/licensed pharmacist in Canada  Had practised for 6 or more years as a registered/licensed pharmacist in Canada  Don’t Know / Unsure * For the purpose of this survey, a “bridging program” is a formal, post-degree program of study specifically designed to address gaps in an IPG’s education or experience and standards of pharmacy practice in Canada and its provinces. Please note that this is not a post-graduate degree program.

2d. Does your pharmacy or head office actively recruit IPGs from outside of Canada?  Yes  No  Don’t Know / Unsure

[SKIP TO QUESTION 4]

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3.

[IF YOU HAVE NOT HIRED ANY IPGS WITHIN THE LAST THREE YEARS] For what reason(s) have you not hired any IPGs in your pharmacy during the past three years? [CHECK ALL THAT APPLY.]  Have not done any recent hiring of pharmacists

 Liability / insurance concerns

 Have not had any job applications from IPGs

 Not sure how to find IPGs to hire

 IPG applicants did not meet qualifications for position

 Would require too high a level of investment in retraining and supervising.

 IPGs applicants lacked sufficient English/French language proficiency

 Patients/clients are less receptive to/accepting of IPGs

 Resumes of IPG applicants did not meet typical Canadian standards (e.g. format, grammar, fluency)

 Other _________________________________

 Don’t Know 4a. In your opinion, is there a need for additional programs/services designed to support IPGs while they are on the path to licensure/registration as Canadian pharmacists?  Yes  No  Don’t Know 4b. [IF YES] What additional programs/services do you think are needed? _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ 4c. What kind of support, if any, does your location offer specifically to IPGs (beyond general employment training or orientation)? [CHECK ALL THAT APPLY.]  None

 Mentoring

 Internships

 Financial assistance with licensing/registration examinations

 Student positions  Language training  PEBC examination process preparation  Don’t Know

 Tuition support for bridging programs  Settlement assistance (e.g. assistance with housing, transit, accessing community resources)  Other: ______________________________________

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5.

To what extent do you feel the following act as barriers to IPGs’ success in the Canadian pharmacy workforce, with ‘1’ being ‘Not a barrier at all’ and ‘5’ being ‘A very significant barrier’? Not a barrier at all

A very significant Don’t barrier know

a) Lack of understanding of the Canadian health care system

1

2

3

4

5

H

b) Lack of understanding of Canadian models of pharmacy practice

1

2

3

4

5

H

c) Lack of proficiency in applying clinical knowledge in a Canadian setting

1

2

3

4

5

H

d) Lack of a drug and therapeutic knowledge

1

2

3

4

5

H

e) Lack of profession-specific technical and procedural knowledge (e.g., computer software)

1

2

3

4

5

H

f) Lack of proficiency in written English or French

1

2

3

4

5

H

g) Lack of proficiency in spoken English or French

1

2

3

4

5

H

h) Lack of proficiency in communicating effectively with patients/clients

1

2

3

4

5

H

i) Lack of proficiency in communicating effectively with other pharmacy staff and other health care providers

1

2

3

4

5

H

j) Lack of practical experience working in a Canadian pharmacy

1

2

3

4

5

H

k) Lack of accurate information regarding licensing/registration process

1

2

3

4

5

H

l) Lack of resources to assist in preparing for licensing/registration exams

1

2

3

4

5

H

m) Length of time required for licensing/registration process

1

2

3

4

5

H

n) Financial burden of licensing/registration process

1

2

3

4

5

H

o) Lack of information about how to find pharmacist employment in Canada

1

2

3

4

5

H

p) Provincial differences in licensing/registration requirements specific to IPGs that limit labour mobility

1

2

3

4

5

H

q) Cultural differences between Canada and the IPG’s country of origin

1

2

3

4

5

H

5r.

Please provide any other potential barriers to IPG success in the Canadian pharmacy workforce, if any. _____________________________________________________________________________________

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6.

In your opinion, how effective are the following facilitators in assisting IPGs in successfully becoming pharmacists in Canada, with ‘1’ being ‘Not effective at all’ and ‘5’ being ‘Very effective’? Not effective at all

Very Don’t effective know

a) Information about the process of becoming licensed/registered to practise as a pharmacist in Canada

1

2

3

4

5

H

b) Bridging programs for IPGs*

1

2

3

4

5

H

c) Preparatory resources for examinations

1

2

3

4

5

H

d) Available support programs** for immigrants (not necessarily designed for IPGs)

1

2

3

4

5

H

e) Practice opportunities provided by employers

1

2

3

4

5

H

f) Structured practical training

1

2

3

4

5

H

g) IPG communities or professional networks

1

2

3

4

5

H

h) Mentoring opportunities

1

2

3

4

5

H

i) Available English- and/or French-language training

1

2

3

4

5

H

1

2

3

4

5

H

1

2

3

4

5

H

1

2

3

4

5

H

j) Information and services provided by the Pharmacy Examining Board of Canada (PEBC) k) Information and services provided by the Provincial Regulatory Authorities l) Other (please specify)

* **

7.

For the purpose of this survey, a “bridging program” is a formal, post-degree program of study specifically designed to address gaps in an IPG’s education or experience and standards of pharmacy practise in Canada and its provinces. Please note that this is not a post-graduate degree program. A “support program” can span a large range of services including language training, résume preparation, and settlement services (assistance with housing, transit and accessing community resources).

Please indicate your level of agreement with each of the following statements regarding IPGs, with ‘1’ being ‘Strongly Disagree” and ‘5’ being ‘Strongly Agree’. Strongly disagree

Strongly agree

Don’t know

a) IPG employees provide valuable new/alternative health information and approaches to practice

1

2

3

4

5

H

b) IPG employees require more supervision than Canadian graduates

1

2

3

4

5

H

c) IPG employees provide important cultural or language benefits to my patients/clients

1

2

3

4

5

H

d) IPGs require specialized support in order to meet Canadian entry-topractice standards and become licensed/registered

1

2

3

4

5

H

e) IPGs are generally more experienced than new Canadian graduates

1

2

3

4

5

H

f) IPG employees require more training than Canadian graduates

1

2

3

4

5

H

g) IPG employees provide access to new patients/clients

1

2

3

4

5

H

h) IPG employees are more willing than Canadian graduates to work in under-served areas

1

2

3

4

5

H

i) IPGs require specialized bridging education to successfully practise pharmacy in Canada

1

2

3

4

5

H

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8.

Within the next three years, how likely are you to hire one or more IPGs at your pharmacy as a:

Very unlikely

Very likely

Don’t know

a) Pharmacy manager or supervisor

1

2

3

4

5



b) Staff pharmacist

1

2

3

4

5



c) Pharmacy technician or assistant

1

2

3

4

5



9.

Which of the following best describes your pharmacy?

10.

 Health care facility (hospital, long term care)

 Independent pharmacy

 Chain, banner or franchise drug store

 Other

Would you consider participating in a paid focus group to discuss the issues raised in this survey in more detail?  Yes

11.

 No

Part of the research being undertaken for this study includes surveys and focus groups with IPGs. Would you be willing to assist the researchers in identifying IPGs to potentially participate in this study?  Yes

 No

Please return your completed survey in the enclosed postage-paid envelope or by one of the following methods: Toll-free fax: 1-866-288-1278 Toll-free telephone: 1-877-688-5051

Mail:

R.A. Malatest & Associates Ltd. 400 – 294 Albert Street Ottawa, ON K1P 6E6

To complete online, please go to the following URL: http://survey.malatest.com/Pharmacist_Employer Your password to access the online survey is the number located on the bottom right-hand corner of the survey. If you have any questions, please contact: R.A. Malatest & Associates Ltd. 400 – 294 Albert Street Ottawa, ON K1P 6E6 Toll-free telephone: 1-888-689-1847

THANK YOU FOR COMPLETING THIS IMPORTANT SURVEY

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Research Appendices

Appendix C: Interview Guides Research on International Pharmacy Graduates – Stakeholder Interview Guide The pharmacy profession needs your help in collecting information to better prepare the pharmacy workforce for the health care needs of the future. The research is part of Moving Forward: Pharmacy Human Resources for the Future, a collaborative initiative led by the Canadian Pharmacists Association and its national pharmacy organization partners. This initiative was launched in 2005 and is funded by the Foreign Credentials Recognition Program of Human Resources and Social Development Canada. The Canadian Pharmacists Association (on behalf of the Moving Forward Initiative) has commissioned R.A. Malatest and Associates Ltd., a private research firm, to undertake research exploring the human resources issues and challenges faced by international pharmacy graduates (IPGs) in the Canadian pharmacy workforce. The research includes a series of interviews with key informants involved with international pharmacy graduates, or with the pharmacy profession in general. Thank you for your involvement in this important research.

Objective of the Survey:

To obtain the perspectives of key informants on issues and challenges facing international pharmacy graduates in Canada.

Confidentiality:

Information provided by respondents will be kept confidential, and results will be reported and provided to the Canadian Pharmacists Association in summarized form only, without identifying individual respondents.

Questions:

If you have any questions about the interview, or the research in general, please call Sarah Leger of R.A. Malatest and Associates Ltd., at (toll-free) 1-888-689-1847. Contact Information

Name:  Dr.  Mr.  Mrs.  Ms.  Miss. (First) ______________________________________ (Last)____________________________________________________ Job Title: ____________________________________ Organization: _____________________________________________ Telephone: ( _________ )__________________________ Fax: ( _______ ) _______________________________________ E-mail: [email protected] _______________________________________________________________ SECTION A:

STAKEHOLDER INFORMATION (ALL STAKEHOLDERS)

A1a. Which of the following describe(s) your role(s) related to international pharmacy graduates or to the pharmacy profession in general? For the purposes of this survey, an “international pharmacy graduate” is defined as anyone who obtained their pharmacy degree outside of Canada. (CHECK ALL THAT APPLY) ˆ

Pharmacy manager/owner

ˆ

Educational / training institution representative (college, university, or private training educators)

ˆ

Provincial regulatory authority representative

ˆ

Association representative

ˆ

Settlement/Support services representative

ˆ

Government representative

ˆ

Organization representative

ˆ

Human resources specialist

ˆ

Other, Please specify:_______________________________

A1b. Please describe the extent of your experience/involvement with international pharmacy graduates (IPGs).

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SECTION B:

LICENSING

The first questions ask about the licensing requirements and the process by which international pharmacy graduates become licensed to practice in Canada. The “licensing process” refers to any of the necessary steps required to become licensed and practice as a pharmacist in Canada. This can include the Pharmacy Examining Board of Canada (PEBC) Evaluating Examination (for IPGs educated outside of North America only), the PEBC Qualifying Examinations, or any specific step or requirement as set out by provincial regulatory authorities such as structured practical training, fluency, and jurisprudence examination. B1a. Do you feel that the licensing process for IPGs is appropriate and effective? (See Appendix A for details on licensing requirements per province.) B1b. Please explain your answer: B2.

Please suggest any ways that the licensing process for IPGs could be improved.

B3.

What challenges or barriers do international pharmacy graduates face in the process of obtaining licensure?

B4.

What would help IPGs to overcome these challenges or barriers?

SECTION C:

BRIDGING AND SUPPORT PROGRAMS AND COURSES

C1.

An important part of this research is building an inventory of current and planned bridging or support services available to international pharmacy graduates. What are the programs and courses (current/planned) available to international pharmacy graduates that you are aware of? For the purpose of this research, a “bridging program” is a formal, post-degree academic program of study designed to address gaps in education or experience and standards of pharmacy practice in Canada. Please note that this is not a post-graduate degree program. A “support program” can span a large range of services including language training, resume preparation, and settlement services (assistance with housing, transit and accessing community resources). C2.

In your view, how well do existing bridging and other support programs or courses prepare international pharmacy graduates for licensure and/or integration into pharmacy practice in Canada? (NOTE THE PROGRAMS/COURSES AND CORRESPONDING COMMENTS FOR EACH)

C3.

Are there any gaps in terms of the existing programs or courses available for support or bridging of IPGs (e.g., gaps in scope, location, focus, etc)? If yes, please explain the gap(s) and potential solutions to address those gaps.

C4.

What challenges or barriers do international pharmacy graduates face related to accessing or completing these courses or programs, if any?

C5.

What would help to overcome these challenges or barriers?

SECTION D:

78

IPG LABOUR MARKET

D1.

What challenges or barriers are IPGs facing in finding and obtaining employment as pharmacists in Canada?

D2.

What types of programs, services or resources, if any, are assisting IPGs in finding and obtaining employment? How effective are they, in your opinion?

D3.

What is currently being done regarding recruiting of IPGs from outside Canada? Is this recruitment effective? How could it be improved?

D4.

What challenges or barriers are IPGs facing in successfully practicing as pharmacists in Canada?

D5.

Please describe any skill or training deficiencies that you have seen in the IPGs working in the Canadian pharmacy workforce.

D6.

What, if any, supports or services for international pharmacy graduates are being offered by employers in Canada?

D7.

How successful have these programs or supports been? Please explain your answer.

D8.

What are the benefits or advantages for employers of employing IPGs?

D9

Do employers have any concerns with hiring or employing IPGS? If so, what are these concerns?

© 2008 Canadian Pharmacists Association

Research Appendices

SECTION E:

COORDINATION

E1.

What types of coordination, networking, partnerships or information-sharing (between programs, levels of government, organizations, pharmacies etc.) are being undertaken, if any, to assist in the recruitment, licensing and/or integration of IPGs into the Canadian pharmacy workforce?

E2.

Are there any current gaps or needs in terms of coordination, networking, partnerships or information-sharing that are affecting the recruitment, licensing and integration of IPGs into the Canadian pharmacy workforce?

E3.

What are the barriers or challenges that prevent/limit cooperation and coordination?

GOVERNMENT (FEDERAL, PROVINCIAL, MUNICIPAL) STAKEHOLDERS F1.

What initiatives, if any, has your department undertaken with respect to access to regulated employment?

F2.

Do you have any comments or concerns about the pharmacy profession’s approach to licensing of international pharmacy graduates?

F3.

Can you please describe any initiative you have specifically aimed at recruiting or integrating internationally trained individuals?

RECRUITERS F4.

What specific challenges have you encountered in recruiting IPGs?

F5.

What specific challenges have you encountered in enabling IPGs to become licensed in Canada?

SETTLEMENT/SUPPORT SERVICES F6.

Can you provide information on your typical clients?

F7.

Can you describe your organization’s services to newcomers

F8a.

Does your organization serve internationally educated pharmacists?

F8b.

IF YES, can you articulate some of the challenges encountered by this particular group?

PROVINCIAL REGULATORY AUTHORITY STAFF ONLY F9.

How are IPGs made aware of the need to register with your organization?

F10.

How much guidance do IPGs need through the process of getting registered?

F11.

Please review the relevant table in Appendix A containing details on licensing requirements for IPGs for your province. a) Is the information accurate and up-to-date? b) From what you know, are there any expected changes to licensing requirements for IPGs for your province?

l Pharmacy Stakeholder Interview Guide Research on International Pharmacy Graduates – Program/Support Provider Interview Guide The Canadian Pharmacists Association has commissioned R. A. Malatest and Associates Ltd., a private research firm, to undertake research exploring the human resources challenges faced by international pharmacy graduates (IPGs) in the Canadian pharmacy workforce. The research is part of Moving Forward: Pharmacy Human Resources for the Future, an initiative launched in 2005 and funded by the Foreign Credentials Recognition Program of Human Resources and Social Development Canada. The information collected in this interview will be used to inform this important study and initiative. The information collected will not be linked to any specific names of individuals. Your responses to all questions of opinion will be anonymous and confidential and not linked to any specific institution. Information of fact about your institution’s program(s) or course(s), such as the number of enrolled students and duration of program, may be reported with the name of your institution. Thank you very much for your participation in this important research. Purpose of the Research x To document the processes and individual steps that IPGs must undergo between their decision to immigrate to Canada and their successful licensure to practice in Canada. x

To develop a detailed inventory of current support or bridging programs available to IPGs.

Integration of International Pharmacy Graduates into the Canadian Pharmacy Workforce: Barriers and Facilitators

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x

To develop a basic demographic profile of international pharmacy graduates in Canada.

x

To conduct research to understand the attitudes and experiences of IPGs regarding their quest to achieve licensure and integrate into Canadian pharmacy practice.

Research undertaken for this study may also inform other research being undertaken by the Canadian Pharmacists Association. Please provide the name and job title of the person participating in this interview: Title:

Mr.

Mrs.

Name:

_________________________________

Surname:

______________________________________

Job Title:

_________________________________

E-mail:

______________________________________

Telephone:

_________________________________

Fax:

______________________________________

Organization and Address:

Miss.

Ms.

Dr.

__________________________________________________________________________

____________________________________________________________________________________________________

SECTION A: A1.

RESPONDENT INFORMATION

Please describe your position and role in providing bridging and/or support programs or courses for international pharmacy graduates (IPGs).

For the purposes of this survey, an “international pharmacy graduate” is defined as anyone who obtained their pharmacy degree outside of Canada. SECTION B:

PROGRAMS AND/OR SUPPORT OFFERED

B1. The following section asks detailed questions about the IPG program(s) or course(s) offered by your organization. This information will primarily be used to develop an inventory of IPG supports and programs. Do we have your consent to include any factual information you provide in this interview about your program(s) or course(s)? B2a. For each IPG program or course currently offered by your institution, please provide the following information. Name of Program(s) or Course(s)

Type of Program or Course*

Only available for pharmacists? (CHECK IF YES)

Only available for internationallyeducated? (CHECK IF YES)





1.

*Types of programs can include, for example: x University-based program x Community-college based program x Private vocational college-based programs x Programs offered by private consultants x Others B2b. For each IPG bridging and/or support program or course currently offered by your institution, please provide the following information.

Name of Program(s) or Course(s)

1.

80

Duration

Full- or Part-time?

Offered how many times per year?

# of seats available 2007 (if applicable)

# of enrolled students (2007)

% of enrolled Check if students who there is a pass the waitlist program %



© 2008 Canadian Pharmacists Association

Research Appendices

For the purpose of this study, a “bridging program” is a formal, post-degree program of study designed to address gaps in an IPG’s education or experience and standards of pharmacy practice in Canada. Please note that this is not a post-graduate degree program. A “support program” can span a large range of services including language training, resume preparation, and settlement services (assistance with housing, transit and accessing community resources). B2c. Please detail how much students must pay to take these programs or courses. Name of Program(s) or Course(s)

Cost of Tuition per individual

Other Costs (books, etc.) (Specify)

1. B2d. How are the program(s) or course(s) funded? Is there any funding available for IPGs to assist in paying tuition or other costs? If yes, please specify what type(s) of funding is available, how much, and repayment options, if known. B2e. What is the structure and content of each of these courses? For example, how does the program provide practical, hands-on training? B2f.

When were the program(s) and/or course(s) started? Why were they initiated? What skills gaps/needs were they developed to address?

B2g. How was the curriculum designed, developed and validated? How is it updated? B2h. What are the specific requirements for admission to these courses or programs (e.g. language fluency, residency status, interview process, application fee, requirement that applicant has passed the PEBC Evaluating Examination, etc.)? B3a. At what point in the licensing or practice process do IPGs typically take the programs or courses offered at your institution? B3b. For what reason(s) do IPGs typically take the(se) program(s) or course(s)? (For e.g., to pass PEBC Qualifying exams, directed by employer, to refresh skills, etc.) B4.

What are common reasons for IPGs not completing the programs or courses at your institution (e.g. why do they typically drop out, fail, or chose only to complete some parts of the program)?

B5a. How do IPGs typically find out about your program(s) or course(s)? What methods are used to advertise or publicize the programs/courses? B5b. In your opinion, how successful has your program been in reaching IPGs? What are the barriers to reaching IPGs? Do you feel there are IPGs who are not aware of your programs or courses who could potentially benefit from them? B6.

Have there been any significant changes to the number of IPGs in these programs or courses over the last five years? If so, what have been the changes, and why?

B7.

Do you expect any change to the number of IPGs in these programs or courses in the next 5 years? If so, what change do you expect, and what are the reasons for these expected changes?

B8.

Are there any planned or expected future changes to the IPG programs or courses offered at your institution? For example, does the institution plan to make any curricular changes, expand the programs, enter into partnerships, etc.?

SECTION C: C1.

OUTCOMES OF GRADUATES

What skills, attitudes or knowledge do you feel IPGs take away from your programs or courses? What additional benefits, if any, accrue to IPGs that take your programs or courses?

C2a. For each program or course offered at your institution, if applicable, can you estimate the proportion of program participants who subsequently pass the PEBC Qualifying Exams and go on to work as pharmacists in Canada?

Name of Program or Course

1.

% of program participants who pass Qualifying Exam Part I %

Typical or average # % of program % of program Typical or average # of of attempts required participants who participants who pass attempts required to pass to pass go on to work as Qualifying Exam Qualifying Exam Qualifying Exam pharmacists in Part II Part II Part I Canada %

%

C2b. Does your institution formally track these types of outcomes through follow-up with former students? If so, how do you obtain this information (e.g. self-reporting by IPGs, information provided by PRA, other)? Do students stay in contact with former instructors after their program(s) or course(s)?

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C3a. Have these programs or courses been subject to a review or evaluation? If so, can you please provide a copy of the results to help inform this project? If a report cannot be provided, could you summarize the findings for us or provide us with some major findings? C3b. Have you collected or received any client feedback on the IPG program(s) or course(s)? If so, can you provide or summarize this feedback to help inform this project? C4.

In your opinion, what additional supports or assistance would improve the outcomes of IPGs who take these programs or courses? What are the needs that are not being met by the programs or courses?

SECTION D:

CHALLENGES AND NEEDS OF INTERNATIONAL PHARMACY GRADUATES

D1.

In your opinion, what are the major challenges facing IPGs in successfully integrating into the workforce in Canada?

D2.

What are the major skills and knowledge gaps facing IPGs as they attempt to integrate into the workforce?

D3.

What skills and knowledge do IPGs need that your program(s) or course(s) cannot provide?

SECTION E:

CHALLENGES OF IPG EDUCATORS

E1.

Can you share some of your challenges as an educator of IPGs? These can include, for example, systemic challenges, or specific challenges encountered related to the diversity of IPGs.

E2.

Do you feel that you have all the supports and assistance you need as an educator of IPGs? If not, what would assist you?

E3.

Do you feel there are sufficient linkages and partnerships between your program(s) or course(s) and other pharmacists and pharmacies? Please explain your answer.

ADDITIONAL COMMENTS F1. Do you have any other comments you would like to make about any of the issues raised in this interview? F2. Would you be willing to distribute information about this research project to your current or former learners? Thank you very much for your participation in this important research.

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Appendix D: Focus Group Moderator Guides International Pharmacy Graduate Employer Focus Group Moderator’s Guide Introduction

5 min

Welcome! I’d like to thank you all very much for coming to this discussion group today. My name is ____________. I am a researcher with R.A. Malatest & Associates Ltd, a Canadian research and evaluation company. Our purpose is to get your insights and understanding of issues surrounding the integration of international pharmacy graduates in Canada. We are hearing from international pharmacy graduates and pharmacy employers such as yourselves through a series of discussion groups across Canada. As many of you know, we have also done surveys with both international pharmacy graduates and pharmacy employers. This research is part of a larger research project called Moving Forward: Pharmacy Human Resources for the Future. The project is led by the Canadian Pharmacists Association and its partners. It is funded by the Government of Canada’s Foreign Credential Recognition program. First of all, I would like to take a minute to explain how we will proceed with this discussion: ¾ The focus group should take about one and a half hours. There will be two parts to the focus group. The first part will be an open discussion, the latter will be focused on your comments on some findings from our survey of employers. ¾

The session will be audio and/or video taped. The recording equipment is [equipment location]. We tape focus groups to make sure the results we present are accurate. [Indicate mirror and observers.]

¾

Anything you say will remain confidential—that is, your name will not be associated with anything you say, and we will just use first names.

¾

I’d like to point out that there are no right or wrong answers and that I am not looking for group agreement on each topic. We would like to hear a diversity of answers and perspectives.

I would like to remind you that, for the purposes of the study, international pharmacy graduates are defined as those who obtained their undergraduate pharmacy degree outside of Canada. So, if everyone is comfortable, we will now get started. Self-Intro

5 min

Let’s start the discussion by going around the table and having everybody introduce themselves. Please tell us your first name, plus a little bit about your position in the pharmacy and the size and type of pharmacy (independent, chain, hospital, etc.)

m loyment

min

1. Has your organization employed any internationally educated pharmacists? This may include IPGs hired as licensed pharmacists, or to fulfill their training requirements. 2. For those that have: What do you think have been the benefits of employing IPGs? [Prompt, if necessary: To what extent do they bring specific types of experiences or knowledge? To what extent do they help in communicating with clients/customers from ethnic communities? Other benefits?] 3. For those that have not: What are the reasons that you have not employed any IPGs? 4. In your opinion, what have been some of the challenges of, or barriers to, employing IPGs, if any? [Moderator to keep lists on flipchart] Training/Supports/Resources

25 min

Next, I would like to hear your perspectives on training, supports, and resources specifically designed to help international pharmacy graduates become integrated into pharmacy practice in Canada. This could include, for example, academic Integration of International Pharmacy Graduates into the Canadian Pharmacy Workforce: Barriers and Facilitators

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bridging programs, internal corporate training, examination prep courses, formal mentorship programs or other types of training. 1. What sort of formal training/supports/resources, if any, has your organization offered specifically for IPGs? How effective have these been, in your opinion? 2.

What other types of training/supports/resources do you think should be made available to IPGs in order to better integrate them into the Canadian pharmacy workforce? Who should provide/fund these types of supports, in your opinion?

[Probe for things like what specific skills or competencies need to be developed, where they need to be developed, how they can be developed.] 3.

What role do you think that you as an employer can take to help integrate IPGs into pharmacy practice? What do you need to assist you in helping IPGs?

4.

Overall, do you generally rely on the system of training, supports and resources outside of your pharmacy to help IPGs with any knowledge, experience or cultural issues/gaps, or do you expect that you as an employer will be responsible for addressing these issues?

Exercise A

20 min

Hand out Exercise A (following sheet). Now, I would like you to have a look at the handout that is being passed out. Please take a few minutes to look over both tables on the sheet. On a separate piece of paper, please take 10 minutes to address the following questions (in point form): ¾

Are these responses in line with your own perspectives and experiences? Is there anything surprising about these results? If so, which answers were unexpected? Why?

We will then discuss your answers as a group. Thank you and Wrap-Up

5 min

Before we end the discussion, are there any other comments or points that anyone would like to discuss? I would like to thank you very much for your participation in this focus group. You have been very helpful to us and we appreciate your input.

International Pharmacy Graduate Focus Group Moderator’s Guide Introduction

5 min

Welcome! I’d like to thank you all very much for coming to this discussion group today. My name is ____________. I am a researcher with R.A. Malatest & Associates Ltd, a Canadian research and evaluation company. Our purpose is to get your insights and understanding of the challenges and issues facing international pharmacy graduates in Canada. We are hearing from international pharmacy graduates and pharmacy owner/managers through a series of discussion groups across Canada. As many of you know, we have also done surveys with both international pharmacy graduates and pharmacy employers. This research is part of a larger research project called Moving Forward: Pharmacy Human Resources for the Future. The project is led by the Canadian Pharmacists Association and its partners. It is funded by the Government of Canada’s Foreign Credential Recognition program. First of all, I would like to take a minute to explain how we will proceed with this discussion:

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¾

The focus group should take about one and a half to two hours.

¾

This session is accredited by the Canadian Council for Continuing Education in Pharmacy (CCCEP), and by completing it you can earn 1.5 continuing education units. To obtain your Continuing Education certificate recognizing these CEUs you can complete the provided sign in sheet at the end of the session.

¾

The session will be audio and/or video taped. The recording equipment is [equipment location]. We tape focus groups to make sure the results we present are accurate. [Indicate mirror and observers.]

¾

Anything you say will remain confidential—that is, your name will not be associated with anything you say, and we will just use first names.

¾

I’d like to point out that there are no right or wrong answers and that I am not looking for group agreement on each topic. We would like to hear a diversity of answers and perspectives.

So, if everyone is comfortable, we will now get started. Self-Intro

5 min

Let’s start the discussion by going around the table and having everybody introduce themselves. Please tell us your name (first name only is sufficient), the year you came to Canada, and briefly about your experience working in your home country in community, hospital, or industry pharmacy practice. A. Coming to Canada

20 min

I would like to hear about your experience in planning for a career as a pharmacist in Canada. 1.

When you considered coming to Canada, what were your career plans or job expectations? [Probe: Did you expect to be working as a pharmacist in Canada?]

2.

Before you settled in Canada, what sources of information, if any, did you use to help plan and prepare to work in Canada? [Moderator to make a list on flip chart] 3.

Which were the most useful? Why? Which were the least useful? Why?

4.

What types of information did you lack that you would have liked to have had or that would have been helpful? Why would these have been helpful? [Moderator to make a list on flip chart] B. Settlement and Licensure

30 min

Now I would like to hear about your experiences since settling in Canada. 1.

What were the reasons that you first settled where you did in Canada? [Probe: Did your career plans have any impact on where you first settled in Canada?]

2.

Are you currently living/working where you first settled in Canada?

3.

How many of you have tried to become licensed to practice as a pharmacist in Canada? How many have been successful?

4. Individual Exercise: On your own, please write down on the paper provided the biggest problems or challenges you have faced in becoming licensed as a pharmacist in Canada. [Share responses with the rest of the group.] If some participants have not attempted to become licensed: Please write down the reasons you have not attempted to become licensed as a pharmacist in Canada. [Moderator to make lists on flip chart] 5.

What, if anything, helped you to deal with or overcome these problems or challenges? What else would have helped you to overcome these problems or challenges? [Moderator to make a list on flip chart]

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C. Bridging/ Support Programs 1.

15 min

Have any of you taken a bridging or support program/course specifically to help you obtain your pharmacist license and/or work as a pharmacist in Canada? x If yes, why did you take the program or course? Did it meet your expectations? Why or why not? x If no, why not?

D. Working in Canada

25 min

1.

What are the biggest problems or challenges you have faced in getting pharmacy-related employment in Canada? For example, this can include finding training positions, or obtaining employment as a licensed pharmacist. [Share responses with the rest of the group.] [Moderator to make a list on flip chart] 2.

a) What helped to address these issues? B) What could/would have helped to overcome these problems/issues?

For those who are or have worked in pharmacy in Canada: 3. Since beginning to work in pharmacy in Canada, what were/are some of the issues, problems or challenges you have faced? What has been the most difficult aspect of working in pharmacy in Canada? [Prompt: these can include anything from working with employers, co-workers or clients to the technical aspects of working in a pharmacy.[ [Moderator to make a list on flip chart] 4.

a) What helped to address these issues? B) What could/would have helped to overcome these problems/issues?

5.

Are you happy with your work situation? [Time permitting: Would you do it all over again? Have you changed your opinion of what working as a pharmacist in Canada means?]

E. Thank you and Wrap-Up

5 min

Before we end the discussion, are there any other comments or points that anyone would like to discuss? I would like to thank you very much for your participation in this focus group. You have been very helpful to us and we appreciate your input.

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Appendix E: Template for Bridging/Support Program Fact Sheets Template for Bridging / Support Program Fact Sheets Name of School Institution/organization Name of Program/course Location of program Program Type Type of Program Purpose of Program Target Clients? Only available for pharmacists? (Y or N) Only available for internationally educated? (Y or N) Program Format Full- or Part-time? (# hours per week) Duration of Program (# weeks) Unique configurations (e.g. links to practical training) In-person or on-line? Offered how many times per year? When? # of seats available (presently) # of enrolled students (presently) Is there a wait list (Y or N) Brief description of the program format Program Content Brief overview of program/course subjects/modules Program Entrance Requirements Specify specific entrance requirements IPG Assessment (pass/fail?, mandatory? Exemptible?) Program Cost and Available Funding Tuition costs Other costs (books, etc. to be specified) Funding available for students? If yes, specify what types. Brief Description of the Program Short Paragraph description of the program, including when it was started and why, if available. How is the program funded? Contact Information and How to Apply How and When to Apply Contact Information (contact name, address, telephone, fax, email, website)

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Program Evaluation Any performance measurement results that can be prepared? Has the program been evaluated? What are some of the key findings?

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ASSOCIATION OF DEANS OF PHARMACY OF CANADA (ADPC) ASSOCIATION OF FACULTIES OF PHARMACY OF CANADA (AFPC) CANADIAN ASSOCIATION OF CHAIN DRUG STORES (CACDS) CANADIAN ASSOCIATION OF PHARMACY TECHNICIANS (CAPT) CANADIAN PHARMACISTS ASSOCIATION (CPhA) CANADIAN SOCIETY OF HOSPITAL PHARMACISTS (CSHP) NATIONAL ASSOCIATION OF PHARMACY REGULATORY AUTHORITIES (NAPRA) THE PHARMACY EXAMINING BOARD OF CANADA (PEBC)

OFFICE OF THE SECRETARIAT

1785 ALTA VISTA DRIVE, OTTAWA ON K1G 3Y6 TEL.: 613-523-7877 • FAX: 613-523-0445 www.pharmacyhr.ca [email protected]

Funded by the Government of Canada’s Foreign Credential Recognition Program

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