1. NARTRB Bridging Programs The Michener Algonquin College

2. Objectives Review the history of educational/bridging supports Discuss the current programs –Michener –Algonquin College Introduce potential for future

3. Experience An individualized plan was developed to bridge the knowledge gaps. This is time consuming and perhaps inefficient. (Courses with one or only a few students) Individuals may have difficulty with self- directed learning.

4. Inquiries to the PLA or retraining process

7. “Typical” potential client (Algonquin College contacts) –Training: 97% physicians; 3% RRTs Minority general practitioners –Approximately 50% have specialty training

8. Challenges for Foreign Trained Professionals: Language issues/ communication skills… may be general or medical related –Listening/speaking/writing/reading –Difficulties increase with speed needs, stress, dealing with other non-English individuals. –Cultural communication influences, such as non verbal cues, tone/loudness of voice etc.

9. Challenges continued Cultural adaptation –Time utilization –Dealing with male female relationships in the educational /clinical setting –Dealing with lines of authority

10. Challenges continued Role adaptation… working within the restraints of a new role in health care versus that of a physician.

11. Challenges continued Self worth –Perceived loss of professional / social status –Sense of “grief” for former career, time in medical school/specialty training –Reduction of “status” with family / community –Sense of defeat for future prospects –Sense of isolation in the community, no support system in place

12. Challenges continued Financial difficulties –Minimal resources …lower pay, a refugee, depletion of resources (unemployment or a survival job) –No financial record in Canada… difficult to acquire loans, loans at high interest rates

13. Challenges continued Frustration with Canadian requirements –Difficulty to access medical placement –Time to acquire access to medical placement –“Misleading” expectations with immigration –Difficulty obtaining original documents

14. Challenges continued PLA processes and retraining options are “minimal, take too long, cost too much to access easily, success rate at PLA is very discouraging.

15. Current bridging program includes: –English for Health Care (onsite) –Ethics for Medical Practice (online) –Legalities (Ontario requirements) (online) –Mechanical Ventilation Review (online) –Pharmacology Review (online) –Preparation for Workplace (onsite) –Comprehensive exam preparation (onsite)

16. T H E M I C H E N E R I N S T I T U T E History at Michener Access and Options –Funding by The Government of Ontario Ministry of Training, Colleges and Universities Access to Professions and Trades Unit (2001- 2005) Respiratory Therapy Medical Laboratory Sciences Diagnostic Cytology Radiological Technology Magnetic Resonance Imaging

17. T H E M I C H E N E R I N S T I T U T E Barriers for International Health Professionals Lack of knowledge experience: –Competency-based exams –Canadian/Ontario Health Care System –Scope of practice ESL Cultural differences Finances

18. T H E M I C H E N E R I N S T I T U T E A&O provides bridge (2002 – 2005) Educational –language referrals –interdisciplinary studies (ethics, law and legislation etc.) –profession-specific courses –preparation courses for certification examinations Financial assistance Canadian clinical experience.

19. T H E M I C H E N E R I N S T I T U T E Success? Stage Two –Our exams are HARD! but fair Full time program – students who do not obtain ~65% not successful challenging the CBRC credentialing exam Stage Three –Course work does not overcome the cultural barriers –Individuals who pass Stage Two with NO courses struggle in clinical Very limited (3/25 successfully completed PLA) Prep for Stage Two –Course work not mandatory –Course work not “must pass”

20. T H E M I C H E N E R I N S T I T U T E 2005-2007 No A&O courses offered due to low enrollment –Lower numbers; affordability; recognition of need CE courses morphed to include all applicants and PLA candidates E learning platform developed –Unfamiliar learning environment/self paced learning Full time courses available for audit or credit –Problem of schedule for individuals working

21. T H E M I C H E N E R I N S T I T U T E How can we improve outcome? Structure –Need for consistent start date to increase numbers for courses –PLA requires open start date for Stage One assessment –Financial cost must be “affordable” –Faculty from Educational institute Process –Entry based on recommendation by A&O Faculty Advisor –Need for increased rigor to assist in “self assessment” –Courses must be spaced to allow time for self study –Progress predicated on success at each “step” Candidate Characteristics –Need to identify profile of successful candidates Experience suggests proficiency in English/education in English Background in anaesthesia and potentially respirology RTs with experience in Saudi or other US medical structure

22. T H E M I C H E N E R I N S T I T U T E Premise of current bridging program Pilot Commenced Fall 2008 Firm foundation in experience (currency and breadth) and knowledge required pre entry to program –Knowledge assessment by didactic exam at time of Stage One interview; require ~40% for recommendation to Bridge Program Courses –Build on foundation – therefore are NOT full time courses on week ends; cover the essentials with ++self learning required –Case based –Assessment of competence through didactic exam; exam covers all competencies required NOT just those covered in “class”

23. T H E M I C H E N E R I N S T I T U T E Current Bridge PilotPLA RT Bridge Program PLA Stage One Assessment of knowledge (PLA Stage Three simulation assessment if successful) Courses –Respiratory care (24hr) –Ventilation (36hr) –Anaesthesia (36hr) –Neo/Paeds (36hr) –Intro to Canadian Healthcare (36hr) –PFT* (24hr) Clinical simulation semester (15 hr/wk) PLA Stage Two PLA Stage Three (concurrent) Clinical Education (~40 hr/wk) * Not essential

24. T H E M I C H E N E R I N S T I T U T E Courses: –50% class room/50% lab –Case based review of content –E learning available to supplement –Required textbooks –Must pass exam at end of course to progress to next course pass mark 60% supplemental exam if first attempt not successful Clinical simulation semester –9 hours per week RT specific Wards ICU Cardiac stress testing Pulmonary function testing Anaesthesia Paediatrics Feedback throughout Assessment of competence –6 hours per week IPC Errors, communication and professionalism Standardized pt interaction

25. T H E M I C H E N E R I N S T I T U T E Who is in Bridging Program? 10 individuals –2 RTs from Philippines –6 MDs 4 recommended by A&O assessment –1 has taken courses previously 2 not recommended by A&O assessment –1 RT from USA taking courses as prep for registration exam (failed previously) –1 RT failed PLA (Stage 2 x 2)previously and granted entrance by CRTO

26. T H E M I C H E N E R I N S T I T U T E Success to date Respiratory Care –All passed 6 required second attempt at exam Ventilation –All passed who have completed exam 3 passed rewrite 1 still to complete rewrite (out of country) (MD)

27. T H E M I C H E N E R I N S T I T U T E Next year? Assess program to identify markers of success Addition of assessment of competency through practical assessment Improved E learning platform