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Dr. Zubin Austin & Marie RocchiUniversity of Toronto
Plenary II: The Experience of the HIRE IEHPs Initiative
The HIRE-IEHP Initiative
Zubin Austin PhD and Marie Rocchi MEdUniversity of Toronto
(on behalf of a cast of thousands)
HIRE IEHPs
HealthforceIntegrationResearch andEducationforInternationally EducatedHealthProfessionals
Background
• Skills shortages in health professions as a media (then public policy) problem in the 1990s – issues of access for patients• Emergence of social justice/equity concerns regarding under-
utilization of well-educated immigrants• Recognition of systemic barriers at the pre-licensure level• Need to maintain public confidence in knowledge and skills of all
health practitioners
….a delicate and challenging balancing act
Background
• Development of pan-professional coalitions of regulators, educators, employers, professional associations to align efforts related to both skills shortages and “the problem” of IEHPs• Emergence of bridging education programs to support social and
professional integration• Development of institutions (e.g. CEHPEA (as it was then known)) • Interprofessional partnerships to align efforts in areas of common
interest (e.g. Orientation to the Canadian Healthcare System)• General interest in ensuring as many IEHPs as possible could progress
to licensure with appropriate supports
How times change….
On the supply side:- Post 2008-recession results in more health professionals working
longer than expected- Increasing numbers of health professionals graduating within Canada- Increasing numbers of Canadians who Studied Abroad (CSAs)
returning homeOn the demand side:- Evolving scope of practice of many professions shifts demand curve- Increasing complexity of health care delivery emphasizes
interpersonal and communicative competency- Risk mitigation around hiring practices
The development of the HIRE IEHPs initiative
• Evolved during a time of labour surplus in many professions• Response to anecdotes regarding differential career trajectories of
IEHPs and Canadian graduates• Issues remain with mal-distribution of healthcare workforce, despite
apparent labour surplus• Increasing concerns expressed by regulators regarding risk mitigation
and the issue of institutional/cultural “fit”• An opportunity for the Health Force Ontario Marketing and
Recruitment Agency (HFO-MRA) and University of Toronto (U of T) to partner using complementary skills and resources to support workplace integration
What was the problem we were trying to solve?
• Getting a license is NOT the end of the story for most IEHPs• Systemic barriers persist within workplaces, which may be beyond
the purview of the OFC or other agencies• These barriers may result in chronic underemployment of IEHPs• Some IEHPs expressed concerns related to cultural integration
outside large urban centres, despite the availability of good-quality jobs• Issue of “Canadian experience wanted” manifests in different ways • Systems for supporting IEHPs which had evolved during a time of
skills shortage seemed uniquely ill-equipped to manage the reality of a time of skills surpluses
Initial Research Findings
• Used an evidence-informed approach to development of curricular tools/resources to support IEHPs and workplaces• Objective was to develop a suite of online resources and supports to
address gaps and needs and identified by diverse stakeholders• Partnership with HFO-MRA was crucial to not only understanding
dimensions of the post-licensure integration issues but to support dissemination and uptake of resources
Initial Research Findings
Employers:• Risk mitigation dominated hiring decisions: high-profile cases of socio-
cultural and linguistic misalignments negatively sensitized some employers• Workplace integration concerns dominated reasoning related to hiring
decisions, yet specifics of “fit” were frequently hard to explain or define• Skills surplus environment resulted in less emphasis on and lower
priority for IEHPs• Employers expressed need for a clear “business case” and workplace
supports related to hiring IEHPs• “A license simply means you’ve met some arbitrary minimum
competency requirement – we want and expect our staff to do better than just minimum competency.”
Initial Research Findings
IEHPs:• Systemic barriers to hiring are real, painful, and confusing• Few supports available post-licensure• Concerns about leaving larger urban centers • Recognition that licensure doesn’t guarantee workplace fit, but
frustrated by lack of available resources/supports post-licensure• Pattern of underemployment post-licensure and relegation to lower-
level jobs in the profession
Initial Research Findings
General:• On-boarding of ANY new staff member is a difficult process: this is
not an IEHP or CSA issue alone• Cultural fit (or “synchronicity”) is a dominant determinant of hiring
decisions and ultimately success in the workplace• Minimum fluency requirements and licensure examinations are not
reliable predictors of workplace success• “Better to have an unfilled vacant position than the wrong person for
the job”: increase in temporary or precarious professional employment not simply limited to IEHPs or CSAs• Diminishing public attention and no formal scrutiny of post licensure
issues
Initial Research Findings
Alternative Careers:- Emerged as a key issue for both employers and IEHPs, both at the
pre- and post-licensure stage- Traditional skills-matching approaches highly unsatisfactory; this is a
highly complex psychological adaptation process requiring individual attention…and time- Career decision making is not a linear or forward process;
pragmatism and pride constantly jockeying for supremacy- Tension between desire for cost saving/efficiency to produce a self-
serve on-line repository of tools and the reality of the need for one-to-one support and counselling
Where we are today
The HIRE IEHPs Initiative- Funded by Health Canada and administered through an agreement
with the Province of Ontario- Partnership with HFO-MRA and University of Toronto- Multifactoral interventions designed to support integrations of IEHPs
in the Canadian workforce through diverse evidence-informed strategies- Three core on-line resources to be used by IEHPs, employers,
settlement agencies, employment counsellors/coaches…and anyone else (including domestically educated health care professionals)
PReP
• Practice Readiness e-Learning Program• Designed around existing University of Toronto curriculum focused on
communication skills, cultural competency, and management of challenging clinical situations• Use of diverse on-line learning strategies including self-assessment,
self-reflection, video-trigger, reading, clinical vignettes, personal stories, etc.
WIN
• Workplace Integration Network• Initially designed around findings of employer-based research related
to barriers and facilitators to hiring of IEHPs; evolved into suite of generally applicable on-boarding resources with particular emphasis on issue of culture, communication, and integration• Use of diverse on-line learning strategies including video-trigger,
clinical/workplace vignettes, games, readings, etc.
ACP
• Alternative Careers Program• Built around recognition that the process of “losing” one’s primary
professional identity is a complex, psychologically fraught process• Grounded in vocational counselling theory related to decision
making, grief, loss, and adaptation• Use of case studies and comparators to support self-identification in
new roles, while still providing support for skills-matching type activities
Practice Readiness e-Learning Program (PReP): Communication Matters• Series of 16 online courses geared towards IEHPs
• Video-based: vignettes, subject matter experts, narration • Learning activities: self-reflections, quizzes, games (e.g. matching) • Additional resources provided for each course• Evaluation surveys embedded in courses• Completion time: 30-60 minutes per course
• Courses focus on communication, workplace issues, and challenging situations in Canadian healthcare context to support successful workplace integration
PReP: Course TopicsPart 1: Foundations Part 2: Advanced Part 3: Workplace Matters
Course 1: Working in Teams Part 1 – Teamwork and the Patient Experience
Course 6: Part 1: Palliative Care 2 – Autonomy and Choice
Course 11: A Primer on Employment Law for Employees
Course 2: Interpersonal Conflict and Conflict Resolution
Course 6: Part 2: Palliative Care 3 – The Healthcare Provider as Patient Advocate
Course 12: The Interview Process
Course 3: Diversity Course 7: The Aging Population Course 13: Working in Teams Part 2 – Collaboration in the Workplace
Course 4: Pandemic: Communication in Stressful Situations
Course 8: Pain – Communication and the Patient Experience
Course 14: Error Disclosure and Apology
Course 5: Palliative Care 1 – Communication and the Patient Experience
Course 9: Gender, Sexuality and Identity Course 15: The Feedback Process
The Bridge (Transition) Course 10: Indigenous Peoples of Canada: Stories and Experiences
Course 16: Workplace Culture and Integration
PReP: Courses
PReP: Courses
Videos, Reflections, Quizzes
PReP and WIN: Log in to track progress
Workplace Integration Network (WIN)
• Series of 9 online courses for employers, human resource managers, supervisors, and employees working with IEHPs• Versatile use: independent learning, staff development, workshop format• Video-based: vignettes, subject matter experts, narration • Interactive quizzes/exercises, reflective questions, tools/templates, resources• Evaluation surveys embedded in courses• Completion time: 15-30 minutes per course
• Courses focus on practical topics to support hiring and successful integration of IEHPs into the workplace• Topics rated highest for potential end-users: cultural diversity in the workplace,
“plain language” communication, interviewing, legal rights and responsibilities
WIN: Course TopicsCourses TopicsCourse 1 Building a Business Case for Hiring and Integrating IEHPsCourse 2 Understanding the IEHP PerspectiveCourse 3 International Academic and Professional CredentialsCourse 4 Professional Regulatory BodiesCourse 5 Part 1 – Open CommunicationCourse 5 Part 2 – Developing an Inclusive Writing StyleCourse 6 Part 1 – Creating a Positive Work EnvironmentCourse 6 Part 2 – A Primer on Employment Law for EmployersCourse 7 Diversity and IntegrationCourse 8 Working in TeamsCourse 9 Workforce Health
WIN: Courses
Course View, Video-Based Courses
Quizzes, Reflections, Exercises
Alternative Careers Program (ACP)
• Series of modules and tools that allow IEHPs to explore alternative career options outside of the regulated health profession in which they were originally trained• Goal to support IEHPs in obtaining gainful alternative careers and
successfully integrating into the Canadian workforce• Self-directed by IEHP or guided by HFO Advisor or Counsellor• Evidence-Informed Program
• Participatory program design • Based on vocational psychology/career counselling literature and
instructional design principles
ACP: Key Literature Findings
• LIM Consulting Associates – research report recommendations included:1
• Creating a central repository of alternative career resources• Developing a series of illustrative alternative career case studies
• Chen, C. P.2
• Cross-Cultural Life-Career Development framework for career counselling with immigrants; importance of self-concept, life-career integration, human agency, contextual awareness, and resiliency
• Novak, L. & Chen, C. P.3
• Described helping strategies for foreign-trained professionals to increase self-efficacy, provide local knowledge, advocate, and promote acculturation
• Savickas, M. L.4
• Narrative constructivist approach to career counselling; construct career through small stories, deconstruct, reconstruct, and co-construct future career with client
1LIM Consulting Associates. (2013). Foreign qualification recognition and alternative careers: Report submitted to the best practices and thematic task team of the foreign qualifications recognition working group. Retrieved from http://novascotia.ca/lae/RplLabourMobility/documents/AlternativeCareersResearchReport.pdf. 2Chen, C. P. (2008). Career guidance with immigrants. In J. A. Athanasou & R. Van Esbroeck (Eds.), International handbook of career guidance (pp. 419–442). Toronto: Springer Science. 3Novak, L. & Chen, C. P. (2013). Career development of foreign trained immigrants from regulated professions. International Journal for Educational and Vocational Guidance, 13(1), 5–24. 4Savickas, M. L. (2011). New questions for vocational psychology: Premises, paradigms, and practices. Journal of Career Assessment, 19, 251–258.
• 10 Integrated Virtual IEHP Cases – exploratory interactive online cases• Demonstrate (through narrative) alternative career pathways and resources• Elicit self-reflection around alternative career options and decision-making
• 6 Online Modules – wrap-around virtual cases and resources• Evaluation surveys embedded in modules• Certificates of completion available• Completion time: 1-2 hours per module
• Database of Resources for Alternative Careers• Includes self-assessment tools, existing resources on alternative careers,
career exploration websites, etc.
ACP: Career Options e-Resource
Landing Page, Modules
ACP: Virtual Cases at a Glance
Logging in to ACP
Book Layout, Resources, Certificates
Virtual IEHP Cases
Virtual IEHP Cases
ACP: Advisor and Staff Manual
• To support advisors, counsellors, and staff using ACP with IEHPs• Includes descriptions of content, activity guide, reflective questions,
and tips for use with clients
Program Evaluation
• Online Course/Module Exit Surveys• Satisfaction with content – value, utility, learning outcomes• User experience – access, navigation, design/organization • Demographic information – e.g. profession, length of time in Canada (IEHPs)• ACP: Readiness to pursue alternative careers
• Follow-up survey, IEHP focus groups, key informant interviews• Pilot testing• Ongoing feedback from Health Force Ontario and end-users• Continuous improvement based on evaluation feedback
Current State
• PReP: 12 courses available • WIN: 6 courses available• ACP: All modules available • Coming Soon…
PReP WINWorking in Teams Part 2: Collaboration in the Workplace
Building a Business Case for Hiring and Integrating IEHPs
The Interview Process Understanding the IEHP PerspectiveError Disclosure and Apology Open CommunicationThe Feedback Process Creating a Positive Work Environment
Working in Teams
HIRE IEHPs: Using the Site
• Online platform allows access to PReP, WIN, and ACP• Open access• Create an account
(username/password) to track progress and complete surveys in PReP and WIN: optional• Account must be
created for ACP
Conclusion
• A suite of online resources has been developed for use by multiple end users, including IEHPs, employers and advisors/counsellors• Open access – all modules to be available by end of March 2017
2017 Perspectives SymposiumMarch 2, 2017
#Perspectives2017
