Program evaluation of a model to integrate internationally educated health professionals into clinical practice

Alternative career pathway decision-support job database for international medical graduates in Canada

Objectives

Canadian regulations have made it challenging for the international medical graduates (IMGs) to get jobs in their original profession as physicians. Consequently, alternative careers are gaining interest among IMGs to avoid underemployment or unemployment. We conducted research to identify the factors that IMGs consider for taking up an alternative career in Canada. Based on those understandings, we aimed to create a database where information about health-related alternative jobs is presented in a searchable way, which can aid IMGs’ strategic job search.

Data description

We first determined job searching preferences and constraints for IMGs regarding alternative career through focus groups. We used their preferred and constraining factors for collecting job-specific information through systematically reviewing job advertisements. Using this information, we created a database that contains available alternative career pathways for IMGs living in Canada. In total, we have identified 1374 job titles under 192 unique job categories comprising 47 National Occupational Classification (NOC) codes that could be suitable for IMGs seeking an alternative career based on their own short, intermediate, and long-term career goals. We expect that this database will help IMGs in deciding on alternative careers.

(Re)producing "Whiteness" in Health Care: A Spatial Analysis of the Critical Literature on the Integration of Internationally Educated Health Care Professionals in the Canadian Workforce

PURPOSE

There is a gap in the literature to understand how professionalizing systems intersect with socioeconomic and political realities such as globalization to (re)produce social inequities between those trained locally and those trained abroad. In this critical review, the question of how systemic racism is reproduced in health care is addressed.

METHOD

Electronic databases and nontraditional avenues for searching literature such as reference chaining and discussions with experts were employed to build an archive of texts related to integration of internationally educated health care professionals (IEHPs) into the workforce. Data related to workplace racialization were sought out, particularly those that used antiracist and postcolonial approaches. Rather than an exhaustive summary of the data, a critical review contributes to theory building and a spatial analysis was overlayed on the critical literature of IEHP integration to conceptualize the material effects of the convergence of globalization and professional systems.

RESULTS

The critical review suggests that professions maintain their value and social status through discourses of "Canadianness" that maintain the homogeneity of professional spaces through social closure mechanisms of credential nonrecognition and resocialization. Power relations are maintained through mechanisms of workplace racialization/spatialization and surveillance which operate through discourses of "foreign-trainedness."

CONCLUSIONS

Movement of professionals supports a professional system that on the surface values diversity while maintaining its social status and power through the (re)production of the discourse of "Whiteness." The analysis shows how in the process domestic graduates are emplaced as the "rightful" citizens of professional paces while IEHPs are marginalized in the workforce.

Clinical Instructors' Perceptions of Internationally Educated Physical Therapists' Readiness to Practise during Supervised Clinical Internships in a Bridging Programme

Purpose: The purpose of this study was to describe clinical instructors' (CIs) comments on the Canadian Physiotherapy Assessment of Clinical Performance (ACP) that reflect areas of strength and areas requiring improvement among internationally educated physical therapists (IEPTs) during supervised clinical internships in a bridging programme. Method: We reviewed the assessment records of 100 IEPTs' clinical performance during two internships each for three successive cohorts of learners in a Canadian bridging programme. We extracted the CIs' text from 385 comment sections of the ACP completed during these internships and analyzed them using qualitative content analysis. Results: The iterative deductive coding process resulted in 36 subcategories: 14 for areas of strength and 22 for areas requiring improvement. We merged the 36 subcategories to produce nine categories: four areas of strength (subjective assessment, treatment, patient confidentiality, and professionalism) and five areas for improvement (objective assessment, clinical reasoning, establishment of treatment goals, communication, confidence, and time management). We then grouped these categories into two broad themes: professional practice and professional conduct. Conclusions: The CIs commended the IEPTs for their clinical competence in subjective assessment, treatment, patient confidentiality, and professionalism. The areas requiring improvement typically required more complex clinical decision-making skills, which may have been challenging for these IEPTs to demonstrate as competently during a short internship.

Using a Logic Model to Design and Evaluate a Quality Improvement Leadership Course

Strong leadership is an essential factor in the success of quality improvement (QI) initiatives that generate and sustain improvements in patient outcomes. Notably, there is a rising need for frontline clinicians, who are often charged with leading QI efforts, to receive training in blended QI and leadership methods and skills. The Leading Healthcare Improvement (LHI) course is a longitudinal leadership course embedded within the Department of Veterans Affairs Quality Scholars (VAQS) program, a multisite interprofessional QI fellowship program. The LHI course was developed to provide frontline clinicians who are emerging QI leaders with the skills to lead and advance improvement efforts at their institutions. It consists of eight 60-minute online sessions and was implemented and delivered to a cohort of interprofessional fellows at 9 sites during the 2017-2018 academic year.This article describes the use of a logic model as a framework to guide the planning, implementation, and evaluation of the LHI course. The authors developed 5 logic model components: inputs, activities, outputs, short-term outcomes, and long-term outcomes. They defined the short-term outcomes using feedback from fellows and an evaluation of the fellows' abstract submissions to the VAQS Summer Institute. Submissions were reviewed to identify how fellows applied the LHI course concepts to QI projects at their respective sites. The authors also collected preliminary impact data from fellows to determine long-term outcomes.Finally, they used the logic model to inform changes to the LHI course based on the evaluation data they collected and developed plans to measure the impact of the course on learners, patients, and the health care system. The authors conclude with lessons learned to guide others who are implementing similar QI efforts.

'Wait and wait, that is the only thing they can say': a qualitative study exploring experiences of immigrated Syrian doctors applying for medical license in Germany

Background

Due to the civil war in Syria, many Syrian citizens have had to flee their country during recent years, among them many physicians. Germany is among the preferred immigration countries. Immigrant Syrian physicians could help overcome the prevailing shortage of medical specialists in Germany. This study explores the experiences and perceptions of Syrian physicians of the licensure process and job application. The study aims at understanding barriers in integrating Syrian doctors into the German health care system.

Methods

We conducted 20 semi standardized interviews with Syrian doctors (n = 17 m; n = 3 f) living in different federal states in Germany. The interviews dealt with the procedure of the accreditation process, its speed and challenges, the interactions with authorities, and the job application process; they were transcribed verbatim. A detailed content analysis was performed.

Results

All interviewees described the licensure process as a complex, lengthy, ever-changing and non-transparent procedure, which is perceived as a partly unfair, sometimes arbitrary bureaucracy. They often feel at mercy of Government employees and report experiences with reviewers who ask for absurd and impossible accomplishments, refuse to give information, and act at random. As a consequence, the interviewees describe themselves as depressed, irritated and/or in despair. According to the interviews, informational and practical support from official institutions was scarce. Instead, the Syrian doctors relied on peers or, in some cases, German friends to understand the requirements and seek information about the licensure process. To find a job placement, it was very helpful, if not essential, to have a German acquaintance establishing contact with possible employers. All three interviewed female doctors reported that their wearing a Hijab led to episodes of discrimination in their job search.

Conclusions

The study points towards the necessity to establish an official information source which provides immigrant doctors with accurate and detailed information about the licensure process, e.g. required documents, estimated waiting times, regulation for courses and exams, criteria regarding credentials, sources of help, etc. Additionally, it seems advisable to consider providing help with regard to the job search and sensitize hospital management for cultural and religious diversity to avoid discrimination.

Qualification programmes for immigrant health professionals: A systematic review

BACKGROUND

Immigrant health professionals are a particularly vulnerable group in a host country's labour market, as they face several barriers when re-entering their occupations. International studies indicate that early interventions can increase the employability of immigrants. Qualification programmes are one of these early interventions that can support the re-integration of these health professionals into the labour market. The purpose of this review is to identify international qualification programmes for immigrant health professionals, analyse their content and evaluate their effectiveness.

METHODS

Six international databases (PubMed, Web of Science, CINAHL, PsychInfo, EBSCO and ProQuest Social Sciences) were systematically searched. The search terms were identified using the PICOS-framework. The review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Articles were screened independently by two authors and discussed. Studies included in the final synthesis were assessed with the Mixed Methods Appraisal Tool (MMAT) and Kirkpatrick's Training Evaluation Model.

RESULTS

Out of 10,371 findings, 31 articles were included in the final synthesis. The majority of them were addressed to international health care professionals and doctors. Two of them were addressed to refugee doctors. Three types of programme elements were identified: teaching, clinical practise and social support. The programmes' length ranged from 2 days to up to 2.5 years. Despite recommendations in its favour, pre- and post-programme support was scarce. Results also indicate a lack of transparency and quality in terms of evaluation. Effectiveness was mostly observed in the area of language improvement and an increase in self-confidence.

CONCLUSION

This review points out the lack of systematically evaluated qualification programmes for immigrant health professionals. Programme providers should focus on implementing programmes for all health professionals as well as for underrepresented groups, such as refugees. In order to generate best practises it is necessary to evaluate these programmes. This requires the development of appropriate instruments when working with immigrant population in the context of educational programmes.

Interprofessional education for internationally educated health professionals: an environmental scan

Objective

The objective of this environmental scan was to identify Western Canadian interprofessional education (IPE) resources that currently exist for internationally educated health professionals (IEHPs).

Methodology

A web-based search was conducted to identify learning resources meeting defined inclusion criteria with a particular focus on the resources available in the Western Canadian provinces. Information was extracted using a standardized template, and we contacted IEHP programs for additional information if necessary. Members of the research team reviewed preliminary findings, identified missing information from their respective provinces, and contacted organizations to fill in any gaps.

Results

The scan identified 26 learning resources for IEHPs in Western Canadian provinces and 15 in other provinces focused on support for IEHPs to meet their profession-specific licensing requirements and to acquire knowledge and competencies relevant to working in the Canadian health care system. Most learning resources, such as those found in bridging programs for IEHPs, included an orientation to the Canadian health care system, components of cultural competence, and at least one aspect of interprofessional competence (eg, communication skills). None of the 41 learning resources provided comprehensive training for IEHPs to cover the six interprofessional competency domains defined in the Canadian Interprofessional Health Collaborative (CIHC) National Interprofessional Competency Framework.

Conclusion

The IEHPs learning resources in Western Canada do not cover all of the interprofessional competencies. This review points to the value of developing a comprehensive IPE curriculum, based on the six domains identified in the CIHC National Interprofessional Competency Framework.

Diversifying the Midwifery Workforce: Inclusivity, Culturally Sensitive Bridging, and Innovation

Midwifery educators and regulators in Canada have begun to address diversity, equity, and inclusion in admission processes and program curricula. Populations served by midwives value internationally educated midwives from their countries of origin. The International Midwifery Pre-Registration Program at Ryerson University in Toronto, Ontario, provides assessment, midwifery workplace orientation, and accelerated education for internationally educated midwives on behalf of the regulatory College of Midwives of Ontario. Between 2003 and 2015, midwives from 41 countries participated in the bridging program, and 214 (80%) successfully completed the program and qualified for licensure. Of these 214 graduates, 100% passed the Canadian Midwifery Registration Examination and 193 (90%) were employed full time as midwives within 4 months of graduation. The program curriculum enables the integration of these midwives into health care workplaces utilizing innovative approaches to assessment and competency enhancement. Critical to the bridging process are simulation-based practices to develop effective psychomotor learning, virtual and real primary care community placements, and coaching in empathetic, client-centered communication. Cultural sensitivity is embedded into the multiple assessment and learning modalities, and addresses relevant barriers faced by immigrant midwives in the workplace. Findings from the 13 years of the program may be applicable to increase diversity in other North American midwifery settings. This article describes the process, content, outcomes, and findings of the program. Midwifery educators and regulators may consider the utility of these approaches for their settings.

Supporting international medical graduates' transition to their host-country: realist synthesis

CONTEXT

Many health services and systems rely on the contribution of international medical graduates (IMGs) to the workforce. However, concern has grown around their regulation and professional practice. There is a need, in the absence of strong evidence and a robust theoretical base, for a deeper understanding of the efficacy of interventions used to support IMGs' transition to their host countries. This study seeks to explore and synthesise evidence relating to interventions developed for IMGs. It aims to provide educators and policy makers with an understanding of how interventions should be developed to support IMGs in their transition to the workplace, particularly looking to identify how and why they are effective.

METHODS

The realist synthesis involved an initial systematic search of the literature for the period January 1990 to April 2015. Secondary searches were conducted throughout the review in order to inform and test the developing programme theory. The context, mechanism and outcome data were extracted from all sources meeting the inclusion criteria. Fourteen case studies were included to further aid theory refinement.

RESULTS

Sixty-two articles were identified, describing diverse interventions of varying intensity. A further 26 articles were identified through a secondary search. The findings illustrate that, alongside a developed programme, ongoing support and cultural awareness at organisational and training levels are crucial. Individual differences must also be taken into consideration. This will ensure that IMGs engage in transformative learning, increase their levels of self-efficacy and cultural health capital, and reduce feelings of stress and anxiety. These factors will have an impact on work, interactions and cultural adjustment.

CONCLUSIONS

Organisational, training and individual contexts all play a role in IMGs' adjustment during the transition process. Establishing ongoing support is critical. A list of recommendations for implementation is given.