ference weicker & company evaluation of the · pdf fileevaluation of the professional...

Evaluation of the Professional Communication for Internationally Educated Health Professionals Course

Final Report Prepared For the Ministry of Jobs, Tourism, and Innovation (JTI) April 21, 2011

Prepared By: Ference Weicker & Company Ltd. 550-475 West Georgia Street Vancouver, BC V6B 4M9 604-688-2424

FERENCE WEICKER & COMPANY

Evaluation of the PC for IEHPs Course Page i


EXECUTIVE SUMMARY

EXECUTIVE SUMMARY

PROFESSIONAL COMMUNICATION FOR INTERNATIONALLY EDUCATED HEALTH CARE PROFESSIONALS

The Professional Communication (PC) for Internationally Educated Health Care Professionals (IEHPs) Course is a program currently delivered by Kwantlen Polytechnic University in British Columbia and Mount Royal College in Alberta. The performance-based Course incorporates communication practice and assists internationally educated health care professionals to further develop their workplace communication skills, recognizing that a lack of English language skills can serve as a major barrier to their successful integration into the work force. The conception and design of the program is based on the connection between language, culture, instruction and assessment that would distinguish the development of professional language proficiency for English Language Training (ELT) programs from other approaches to language instruction.

PURPOSE OF THE EVALUATION The Ministry of Jobs, Tourism and Innovation (JTI) commissioned an evaluation of the IEHP to:

Determine if the curriculum and delivery of the PC for IEHPs Course achieved its intended objectives and student outcomes in BC and AB;

Make recommendations for improvements in the curriculum as well as delivery to meet the Course objectives and increase the number of students taking the Course in BC; and

Compare the curriculum, delivery methods, and outcomes between BC and AB to determine the pros and cons of each version.

METHODOLOGY The methodology used to evaluate the PC for IEHPs Course included the following:

A review of program documents and relevant literature.

Preliminary interviews with representatives of The Ministry of Jobs, Tourism, and Innovation, the Vancouver Coastal Health Authority (VCH), Kwantlen and Mount Royal involved in the development and delivery of the PC for IEHPs Course to confirm the structure and intended outcomes of the program and to obtain input into the development of the evaluation issues and indicators.

Interviews with 10 program representatives associated with the two programs.

A survey of 35 course participants, of whom 16 are past participants from Mount Royal University in Alberta, 8 are past and 11 are current participants of the Course at Kwantlen Polytechnic University in British Columbia.

Field trips to Kwantlen Polytechnic University and Mount Royal College.

Focus groups with 5 stakeholders involved in the program and 5 past Course participants at Mount Royal University.

SUMMARY OF MAJOR CONCLUSIONS

The major findings and conclusions arising from the evaluation are as follows: 1. There is a strong need for the PC for IEHPs.

Evaluation of the PC for IEHPs Course Page ii


EXECUTIVE SUMMARY

Program representatives and participants from both institutes noted that there is a strong need to help IEHPs overcome some of the barriers they face in entering health profession field such as communication barriers, lack of understanding of patient-focused care in Canada, limited medical vocabulary, and lack of familiarity with culturally appropriate behaviors when dealing with patients. The literature review suggests that there is an on-going shortage of health professionals in British Columbia and Alberta as well as other jurisdictions that could be addressed, at least in part, by programs such as PC for IEHPs that provide support and encourage foreign train professionals to pursue careers in the health sector.

2. The curriculum for the Course is considered appropriate to the needs of IEHPs in BC and

Alberta. Although there are some differences in the curriculum and delivery methods between the two programs, there is no data to suggest that one is more or less effective than the other.

The BC-designed curriculum for the Course was adapted to the needs of the IEHPs participating at Mount Royal, Alberta. Major changes included shortening the course from 15 to 13 weeks, placing more emphasis on rehearsals and performance-based instruction in nursing labs and less on ESL instructions, decreasing the number of stimulated patients from 7 to 5, and introducing more activities related to evaluation and monitoring of the students. There are, however, more similarities than differences between the two programs. Both programs are continuing to evolve as experience is gained. One of the strengths is that the two institutions have been willing and able to share information, best practices, lessons learned and resources with each other. Although a common recommendation from participants from both institutions was to extend the length of the Course, it does not appear that the decision to shorten the course at Mount Royal by two weeks has had a negative impact on either achievement of the intended objectives or student outcomes. Achieving cost savings without negatively impacting the quality and effectiveness of the Course is an area of particular importance and focus to representatives at both institutes. Effective program promotion to fill available seats will require more effort in the future, particularly at Mount Royal. The high costs of the program, combined with the limited financial resources of many IEHPs, may mean that direct federal or provincial government funding will be needed to sustain these programs on an on-going basis.

3. The course has been successful in achieving its objectives and intended impacts in the short-term. Factors that contribute to program success include involvement of the healthcare educators, commitment of instructors to meet the individual needs of participants, and the support provided by program partners.

Participants from both Mount Royal and Kwantlen suggested that the Course has been very successful in achieving its objectives in terms of improving their professional communication skills, improving understanding of work culture and the health care system in Canada, building their confidence to pursue a career in health care, and helping them prepare for tests or courses they need to take. Taken together, these outcomes are believed to contribute to the increased likelihood that IEHPs will pursue careers and be successful in obtaining a job in health sector.

Various factors contributed to the effectiveness of the Course including its unique design, which involves health care clinical educators in addition to language instruction, the focus on performance-based learning, and small class size which is optimal for individual focused learning.

Evaluation of the PC for IEHPs Course Page iii


EXECUTIVE SUMMARY

Other essential components of the Course that make it particularly effective and relevant to IEHPs include role-plays and simulated medical scenarios, the opportunities to practice communication with patients and caregivers, and the opportunities to network and offer solutions related to the patient safety issues.

4. The Course should continue to be flexible in adjusting curriculum to meet the needs of the

particular IEHPs, including the extent to which role-plays, rehearsals, written assignments and guest speakers are utilized. The findings of the evaluation suggest that the key aspects of the Course, which make it attractive to participants and set it apart from other similar courses, include its focus on a performance-based individualized learning approach as well as the involvement of clinical instructors and experts in the course. The Course should continue to tailor the curriculum where necessary to meet the needs of participating IEHPs, by inviting appropriate guest speakers and covering the topics that are specifically relevant to the participating professions. The instructors should work closely with IEHPs to develop goals and learning strategies for each participant including the type and focus of assignments, as well as the type of feedback that will be most effective. Clinical instructors should be available to provide feedback for role rehearsals.

5. Other common recommendations arising from evaluation include strengthening recruitment

and promotional strategies, and ensuring that sustainable funding is available.

The recommendations arising from the review of the Course in Mount Royal largely focus on expanding the recruitment and promotion strategies to diversify the type of IEHPs interested in the Course. Health care and immigrant-based organizations could play an important role in promoting awareness of the Course amongst eligible IEHPs. Continued efforts should be made to share information and best practices between the institutions delivering the Course. The results of the evaluation should be made available to other institutions that may be interested in staging a similar program in other regions of the province. In addition, Assistance should be provided to help institutions identify and secure funding needed to sustain delivery, further develop the Course, and expand it to other regions.

Glossary of Acronyms

AB – Alberta BC – British Columbia CELBAN - Canadian English Language Benchmark Assessment for Nurses CLB - Canadian Language Benchmark CLBA - Canadian Language Benchmark Assessment CRNE - Canadian Registered Nurse Exam ELT – English Language Training ELTPA - Enhanced Language Training Placement Assessment IEHPs – Internationally Educated Health Care Professionals IELT - International English Language Training IELTS - International English Language Training System JTI – Ministry of Jobs, Tourism, and Innovation KPU – Kwantlen Polytechnic University M-CAP - Medical Communication Assessment Project MCCEE - Medical Council of Canada Evaluating Examination MCCQE1 - Medical Council of Canada Qualifying Examination Part I MCCQE2 - Medical Council of Canada Qualifying Examination Part II MRU – Mount Royal University OSCE - Objective Structured Clinical Examination PC for IEHPs Course – Professional Communication for Internationally Educated Health Care Professionals Course SEC - Substantially Equivalent Competence TOEFL - Test of English as a Foreign Language VCH - Vancouver Coastal Health Authority

Glossary of Tables

TABLE 1: KWANTLEN POLYTECHNIC UNIVERSITY TABLE 2: MOUNT ROYAL UNIVERSITY TABLE 3: CORE PROGRAM ACTIVITIES TABLE 4: PROGRAM LOGIC MODEL FOR THE PC FOR IEHPS COURSE TABLE 5: PROGRAM DELIVERY & ASSESSMENT METHODS TABLE 6: ELIGIBILITY, RECRUITMENT AND PROMOTION STRATEGIES TABLE 7: PROFILE OF PARTICIPANTS TABLE 8: PROGRAM STAFFING TABLE 9: LOCATION, TECHNICAL & OTHER SUPPORTS TABLE 10: MONITORING, REPORTING, AND FUNDING STRUCTURE TABLE 11: RECOMMENDATIONS PROVIDED BY PARTICIPANTS AND PROGRAM REPRESENTATIVES

Glossary of Charts

CHART 1: NEED FOR THE PROGRAM CHART 2: SIGNIFICANCE OF BARRIERS FACING IEHPs CHART 3: CURRICULUM DESIGN AND APPROPRIATENESS FOR IEHPs CHART 4: PROGRAM PROMOTION CHART 5: INSTRUCTOR QUALIFICATION AND INSTRUCTOR-TO-STUDENT RATIO CHART 6: PROGRAM LOCATION CHART 7: MONITORING AND REPORTING MECHANISMS AND COST-EFFECTIVENESS CHART 8: IMPROVING IEHPs’ COMPETENCY IN THE HEALTH CARE SECTOR CHART 9: SUCCESS IN ENTERING REFERSHER/BRIDGING PROGRAMS, HEIGHTENING UNDERSTANDING, AND INCREASING LIKELIHOOD OF OBTAINING EMPLOYMENT

CHART 10: SUCCESS IN ACHIEVING INTENDED OBJECTIVES

Introduction

1 Background

1 Purpose of the Evaluation

2 Method of Study

3 Structure of the Report

Overview of the PC for IEHPs Course

5 Rationale

5 Target Groups

6 Program Delivery

8 Activities and Outcomes

8 Logic Model

Summary of Major Findings

11 Need for the Course

17 Course Design and Delivery

29 Achievement of Impacts and Objectives

37 Lessons Learned and Opportunities for Improvement

Major Conclusions

40 Major Conclusions

Appendices

A - 1 Appendix I: Questionnaire for PC for Participants

A – 8

Appendix II: Questionnaire for Representatives of JTI, Vancouver Coastal Health Authority, Kwantlen Polytechnic University and Mount Royal University

A – 17 Appendix III: Focus Group Guide: Stakeholders

A – 18 Appendix IV: Focus Group Guide: Participants

A – 19 A – 20

Appendix V: Focus Group Waiver for Participants Appendix VI: Profile of Other Language Related Programs Targeted at Foreign Trained Professionals

TABLE OF CONTENTS


INTRODUCTION

Evaluation of the PC for IEHPs Course Page 1

I. INTRODUCTION

A. BACKGROUND The Professional Communication (PC) for Internationally Educated Health Care Professionals (IEHPs) Course is a program currently delivered by Kwantlen Polytechnic University in British Columbia (BC) and Mount Royal College in Alberta (AB). The PC for IEHPs Course assists internationally educated health care professionals in further developing their workplace communication skills, recognizing that a lack of English language skills can serve as a major barrier to their successful integration into the work force. The Ministry of Jobs, Tourism, and Innovation (JTI) funded the development and pilot delivery of this curriculum. Two pilot Courses were delivered in BC by Kwantlen Polytechnic University in 2009, with delivery of the Course continuing at Kwantlen post-pilot. Twenty-nine people participated in the pilot Courses (15 enrolled in the Course running from January 5 to April 17, 2009 and 14 enrolled in the Course running from September 8 to December 18, 2009). Additionally, the BC-developed course curriculum was licensed by the Province of BC to Mount Royal College in AB upon request. Twelve people participated in the pilot Course at Mount Royal from March 29 to June 29, 2010. The PC for IEHPs is a 3 to 4 month program (15 weeks in BC and 12 weeks in AB plus a one week orientation) designed to help immigrant health professionals from a variety of disciplines (e.g. midwives, nurses, doctors, occupational therapists, pharmacists and physiotherapists) increase their cultural competence (e.g., understanding of culturally expected behaviours of the Canadian health care system), language proficiency and professional communication skills (e.g. pronunciation, health and idiomatic vocabulary, written skills for documentation, and awareness of communication styles) needed to work effectively with culturally diverse clients and colleagues. The performance-based Course incorporates communication practice (language and behaviour) through role-plays in scenarios with clients, families and health teams, coaching of role-plays, filming of rehearsed and unrehearsed role-plays, use of standardized patients/actors, feedback and self-reflection. The Course objective is to bridge the gap between language instruction and workplace communication skills. The framework and content draws from the contributions made by others in the field. The conception and design of the program is based on the Medical Communication Assessment Project (M-CAP). This approach is based on the connection between language, culture, instruction and assessment that would distinguish the development of professional language proficiency for English Language Training (ELT) programs from other approaches to language instruction.

B. PURPOSE OF THE EVALUATION The Ministry of JTI commissioned an evaluation of the PC for IEHPs Course to:

Determine if the curriculum and delivery of the Course achieved its intended objectives and student outcomes in BC and AB;

Make recommendations for improvements in the curriculum as well as delivery to meet the Course objectives and increase the number of students taking the Course in BC; and

Compare the curriculum, delivery methods, and outcomes between BC and AB to determine the pros and cons of each version, including:


INTRODUCTION


C. METHOD OF STUDY The project was completed in two phases. The purpose of Phase I was to develop an evaluation framework and accompanying work plan which was then implemented in Phase II. A description of each phase is outlined below. 1. Preparation of the Evaluation Framework and Work Plan This purpose of the first phase of the project was to:

Design the evaluation in terms of the evaluation issues, performance indicators and data sources;

Define the specific steps required to undertake the evaluation in the second phase of the project; and

Prepare the interview guides that will be used in the evaluation. In preparing the evaluation framework and work plan, we:

Met with the Evaluation Advisory Committee to review the structure of the program and clarify the scope of the outcome evaluation as well as the specific outputs desired.

Conducted preliminary interviews with representatives of JTI, Kwantlen, the Vancouver Coastal Health Authority (VCH), and Mount Royal involved in the development and delivery of the PC for IEHPs Course to confirm the structure and intended outcomes of the program and to obtain input into the development of the evaluation issues and indicators. From these interviews, we were also able to confirm what information is available for evaluation purposes, including the potential to conduct interviews with participants in the Mount Royal Course.

Developed a Program logic model for the PC for IEHPs Course for the purposes of the evaluation. The logic model indicates the major causal linkages between the objectives, activities, outputs, and intended outcomes of the Course. The linkages between the different activities of the Course and the hierarchy of outcomes constitute testable hypotheses, which will form a key point of the evaluation.

Developed draft evaluation questions, indicators and data sources to be used to address each evaluation question. We developed evaluation questions to address the evaluation issues. We also developed the draft sampling strategies, questionnaires and guides for the evaluation.

Developed the methodological tools to be used in the evaluation.

Prepared a data analysis plan that indicated the methods used to analyze the data and how the data from multiple sources would be synthesized to address each evaluation issue.

Prepared the draft Detailed Evaluation Work Plan.

Obtained feedback from the Steering Committee on the framework and work plan. Based on the feedback, we made some revisions prior to proceeding with the field research.

2. Implementation of the Field Research


INTRODUCTION


Upon approval of the work plan, a field research program was implemented which included:

A review of program documentation. Some of the documents reviewed included:

Original proposal and contribution agreements of the PC for IEHPs Course; Program curriculum; Licensing agreement with Mount Royal; Project budget and expenditures data; Progress reports and recommendations prepared by the Course contractor; Program websites; Participant evaluation and instructor feedback; and Pre-and post Canadian English Language Benchmark Assessment for Nurses (CELBAN)

scores. Interviews with 10 representatives associated with the two Programs. Of the 10 program

representatives who were involved in development and/or delivery of the Programs, 6 were Kwantlen Polytechnic University representatives including 2 stakeholders (one VCH representative and an independent contractor), and 4 were Mount Royal University representatives.

A survey of 35 individuals who have participated in one of the Courses at Kwantlen or Mount Royal or are currently participating in the training program in BC or AB. Of 35 participants surveyed:

16 are past participants from Mount Royal University in Alberta; 8 are past participants from Kwantlen Polytechnic University; and 11 are currently enrolled in the Course at Kwantlen Polytechnic University in British

Columbia.

Conducted a field trip to Kwantlen Polytechnic University and Mount Royal University. The purpose of our field trip to Mount Royal University was to meet and interview those involved in the program and conduct focus groups with past participants and stakeholders. The purpose of our field trip to Kwantlen Polytechnic University was to observe operations, attend 2 hours of a class in session, and meet with those involved.

Conducted a focus group with 5 stakeholders involved in the program and a focus group with 5 past Course participants at Mount Royal University. Of the participants, two completed a 2010 pilot spring term and 3 participants completed 2010 fall term Course. Three are physicians and two are nurses.

Conducted a brief literature review to identify the characteristics of similar programs which have been developed and the nature of their target markets.

D. STRUCTURE OF THE REPORT This document is divided into four chapters:

Chapter II provides a description of the Course rationale, its target groups, program delivery, activities and outcomes, and the logic model.


INTRODUCTION


Chapter III summarizes the major findings of the evaluation related to the need for the Course, design and delivery, achievement of objectives, impacts of the program, lessons learned and program representatives’ and participants’ recommendations.

Chapter IV presents the major conclusions arising from the evaluation.



OVERVIEW OF THE PC FOR IEHPs COURSE

II. OVERVIEW OF THE PC FOR IEHPS COURSE

This chapter provides an overview of the PC for IEHPs Course in terms of its rationale, target groups, program activities, intended outcomes, logic model, and program delivery.

A. RATIONALE The PC for IEHPs Course was designed to assist internationally educated health professionals to1:

Improve communication for entry into professional practice;

Improve pronunciation;

Expand health and idiomatic vocabulary;

Improve written skills for documentation;

Increase awareness of communication styles; and

Increase understanding of culturally expected behaviours of the Canadian health care system. The objectives of the PC for IEHPs Course are to:

Provide awareness of the professional culture of health care practice in Canada;

Familiarize internationally educated health professionals (IEHPs) with health professional-patient interactions in Canada through role play of case studies and simulated scenarios;

Provide appropriate language and communication coaching in the development of the expected responses and practices in a range of health care settings;

Use video-taped recordings as a means of critically evaluating health professional-patient communication;

Increase professional language proficiency and enhance performance and confidence for assessments such as the Objective Structured Clinical Examination (OSCE), Canadian English Language Benchmark Assessment for Nurses (CEBLAN), and training in bridging programs;

Familiarize IEHPs with the types of writing tasks required in their health care profession; and

Increase participants’ use of the patient-centre care approach through demonstration, practice, and feedback on participant performance.

B. TARGET GROUPS The curriculum was developed for IEHPs who:

Have an international degree in their health professions;

Have international professional work experience in their field and/or as college or university teachers in academics (some participants may be recent graduates with minimal professional work experience);

Have recently arrived in Canada or have been in Canada for a period ranging from several months to several years or more;

May be employed in the health care sector;

May be unemployed or working in ―survival‖ jobs, or may be full-time homemakers;

May already have started the licensing process;

May have met or have not met fluency requirements for licensing or for admission to bridging programs; and

1 http://www.kwantlen.ca/aca/els/IEHP.html

http://www.kwantlen.ca/aca/els/IEHP.html




Want to increase their language skills in order to meet fluency requirements and be able to work successfully in Canada.

The priority client groups for the Course are a mix of IEHPs from the following professions:

Nursing;

Physicians;

Midwifery;

Pharmacy;

Physiotherapy; and

Occupational Therapy. Eligible IEHPs must meet the language requirements and are assessed using the Canadian Language Benchmark (CLB) Placement Test or Test of English as a Foreign Language (TOEFL)/International English Language Training System (IELTS). Different requirements, described in Chapter 2 (p. 30-31), exist between the Courses offered at Kwantlen Polytechnic University and Mount Royal University.

C. PROGRAM DELIVERY

The following section provides an overview of the stakeholders involved in the funding, design, and delivery of the Course as well as their roles and responsibilities. In British Columbia, funding for the development of the curriculum and delivery of the pilot Course was provided by the Government of Canada and the Province of British Columbia. Phase I of the project was administered by the Fraser Health Authority and Phase 2 by the Vancouver Coastal Health Authority. An advisory committee for Phase I and a working group for Phase II brought together stakeholders to provide guidance and support. The Committee was made up of representatives from Vancouver Coastal Health, Providence Health Care, Fraser Health, Kwantlen Polytechnic University, the BC Ministry of Health Services and the BC Ministry of Advance Education and Labour Market Development. The role and responsibility of each party involved associated with the PC for IEHPs Course in BC is described in the following table.

TABLE 1: KWANTLEN POLYTECHNIC UNIVERSITY

GROUP ROLES AND RESPONSIBILITIES

Ministry of Jobs, Tourism and Innovation

(formerly known as Ministry of Regional Economic and Skills

Development)

Provided funding for the development of the curriculum and delivery of the pilot course at Kwantlen

Collaborating with stakeholders

Conduct Course evaluations

Kwantlen Polytechnic University (BC)

Deliver the Course at the Surrey campus

Fraser Health Authority (BC) Administered Phase I of the pilot project

Vancouver Coastal Health (BC) Administered Phase II of the pilot project

Providence Health Care (BC) Involved in Phase I

Ministry of Health (MOH) Provided funding for Phase I

Project Manager Oversees coordination of the Course

Instructors Teach the PC for IEHPs Course

Language expert

Clinical Educator Fill credibility gap that exists as a result of instructors lack of

experience in the health care workplace





Able to answer participant questions with respect to health care communication and current practices in a Canadian context

Set and expand health care context and participate in and provide feedback to participants in Tuesdays and Thursdays role rehearsals

Essential to providing relevance to clinical practice setting for ESL instructors and participants

Standardized Patient Coordinator Responsible for coordination of standardized patients

Hold debrief sessions with standardized sessions for feedback purposes

Standardized Patients Involved in role plays, filming and feedback procedures

IEHPs Mix of recent immigrants who were educated internationally

Commit 300 hours to the program over the course of 15 weeks

The BC curriculum was licensed to Mount Royal University by the Ministry of Regional Economic and Skills Development (currently known as JTI) and adapted to the context of AB and the institution. The role and responsibilities of the various parties associated with the Course in AB are highlighted in the following table.

TABLE 2: MOUNT ROYAL UNIVERSITY


Alberta Employment and Immigration

Provided funding for pilot of the Course

Ministry of Jobs, Tourism and Innovation

(formerly known as Ministry of Regional Economic and Skills

Development)

Licensed curriculum to Mount Royal University

Mount Royal College Piloted the B.C.-developed curriculum under license and adapted it

to the context of Alberta and the institution

Delivered PC for IEHPs pilot Course over 13 weeks (270 hours)

Instructors Responsible for teaching the Course

Language expert

Health Professional Consultant Selected based on knowledge and experience of the AB healthcare

system and current practices

Attended course twice a week over 10 weeks (80 hours)

Program Coordinator Oversees coordination of the Course

Make weekly edits to the curriculum

Simulation Patients

Three professional actors with experience with the University of Calgary’s Faculty of Medicine’s Standardized Patient Program, one Languages Institute ESL instructor and one second year MRU Bachelor of Nursing student

Review case material received by Program Coordinator specifying their role

Involved in role plays, filming and feedback procedures

IEHPs Mix of recent immigrants who were educated internationally

Commit 270 hours to the program over the course of 13 weeks




D. ACTIVITIES AND OUTCOMES The major program activities include recruitment and intake, delivery and evaluation, referrals and service bridging. The following table summarizes the core program activities in all three areas.

TABLE 3: CORE PROGRAM ACTIVITIES

ACTIVITIES EXAMPLES

RECRUITMENT

AND INTAKE

Promoting and advertising the program

Recruiting participants, instructors, clinical educators, standardized patient care coordinator and standardized patients

Training instructors, clinical educator, standardized patient coordinator, and standardized patients

Conducting intake process

Administering Institutional CELBAN as participant entry assessment

Developing and adjusting curriculum for learners

DELIVERY

AND EVALUATION

Introductory orientation sessions where course expectations are outlined

Providing performance-based teaching including: communication practice (language and behaviour) of role-plays: clients, families and health teams, coaching of role-plays, filming of rehearsed and unrehearsed role-plays, use of standardized patients/actors, and feedback and self-reflection

Administering Institutional CELBAN as learner exit assessment

Conducting learner satisfaction survey

REFERRALS AND

SERVICE BRIDGING

Making referrals of individual participants to basic and specialised services and resources

Collaborating with partners and other programming

The overall expected participant outcomes of the Course are as follows:

Improvement in language competency specific to the health care sector;

Greater understanding of Canadian health care communication;

Demonstrated improvement in the level of English language proficiency in simulated health care contexts; and

Movement towards meeting the requirements for entry into refresher/bridging programs and regulatory organizations.

E. LOGIC MODEL The logic model was developed to increase the understanding of linkages between the activities, outputs and intended outcomes of the Course. As illustrated in the table on the following page, the activities of the Course lead to a number of immediate outcomes (changes in skills and knowledge that could be demonstrated immediately upon the completion of the Course), and intermediate outcomes that can be demonstrated after some time has passed (e.g. within the first year of completing the Course).




In the case of the PC for IEHPs Course, immediate outcomes of the Program concerning participants include their improved English language skills and increased understanding of the cultural and communication needs within Canadian health professions. After participating in the Course, participants should be able to demonstrate increased knowledge of the Canadian health care system including professional-patient interactions, enhanced performance and confidence as well as improved communication for entry into professional practice. Intermediate outcomes of the Course for participants include:

Improved results after taking competency exams. As a result of participating in the Course, IEHPs are better equipped with the confidence and skills necessary to perform well on competency exams such as the Objective Structured Clinical Examination (OSCE) and Canadian English Language Benchmark Assessment for Nurses (CELBAN).

Increased likelihood of obtaining licenses in their specific health care field. The skills acquired by participants who have completed in the Course aid in the preparation for licensure.

Improved ability to meet requirements for entry into refresher/bridging program and regulatory organizations. After participating in the Course, participants are better prepared to access or meet bridging program requirements, and successfully apply for membership in a regulatory organization.

Increased likelihood of obtaining and retaining jobs in the health care sector. By improving their English language competency and becoming familiarized with the professional culture of health care practice in Canada, participants are better able to compete for and secure jobs in their relevant health care discipline.

Improved ability to meet personal and professional goals. Participants’ involvement in the Course has raised their confidence levels and helped them to meet their goals.

TABLE 4: PROGRAM LOGIC MODEL FOR THE PC FOR IEHPs COURSE

Program PC for IEHPs Course

Activities

Promote and advertise the Course Recruit participants, instructors, clinical educator, standardized patient care

coordinator and standardized patients Conduct intake process Train instructors, clinical educator, standardized patient care coordinator and

standardized patients. Institutional CELBAN administered as entry assessment for participants Provide an orientation session prior to the start of the Course Provide performance-based instruction Institutional CELBAN administered as exit assessment for participants

Outputs

# of promotional activities conducted # of participant applications received # of participants accepted into the Course Institutional CELBAN results for entry assessments for participants # of instructors, clinical educators, standardized patient coordinators and

standardized patients trained # of hours of instruction provided




Program PC for IEHPs Course

Institutional CELBAN results for exit assessments of participants Evaluation reports

Immediate Outcomes

Improved language competency specific to the health care sector Improved communication for entry into professional practice Heightened awareness of various communication styles used in Canadian health

care Increased understanding of culturally expected behaviours and the professional

culture of the Canadian health care system Increased familiarization with health professional-patient interactions in Canada Demonstrated improvement in level of English language proficiency in simulated

health care contexts Familiarization with types of writing tasks required in health care professions Enhanced performance and confidence

Intermediate Outcomes

Improved results in competency exams Increased likelihood of obtaining licenses in various fields Improved ability to meet requirements for entry into refresher/bridging programs and

regulatory organizations Participants more likely to obtain and retain jobs in the health care sector Improved ability to meet professional goals

Final Outcomes

Internationally Educated Health Professionals become effective participants in the Canadian health care system and make significant contributions to the health of Canadian residents



SUMMARY OF MAJOR FINDINGS

III. SUMMARY OF MAJOR FINDINGS

This chapter provides a summary of the major evaluation findings regarding Program need, design, delivery, and outcomes. A. NEED FOR THE COURSE The major findings of the field research regarding the need for the PC for IEHPs Course are as follows: 1. Most program representatives and participants believe that there is a major need for the PC

for IEHPs Course, as evidenced by the increasing demand for the Program.

When asked to rate the need for the PC for IEHPs Course, on a scale of 1 to 5, where 1 is no need at all, 3 is somewhat of a need, and 5 is major need, most program representatives and participants from both Kwantlen and Mount Royal indicated there is a high need. The average rating for Mount Royal program representatives was 4.3 and the average rating for Kwantlen program representatives was 5.0. Mount Royal participants provided an average rating of 4.5 while Kwantlen participants provided an average rating of 4.7.

CHART 1: NEED FOR THE COURSE

Kwantlen program representatives and participants provided the following input regarding the need for the Course:

Program representatives attributed the strong need for the Course and the services to the

high demand for the Course experienced in BC. The upcoming class (May 2 – August 12, 2011) of 18 spaces filled very quickly (has been full since early February 2011). In 2011, 53 IEHPs were accepted into the Program compared to 32 participants in the previous year.

The Course is able to address the demands of professional practice related to collaboration,

4.3

4.5

4.7

5.0

1 2 3 4 5

Mount Royal Program Representatives (n=4)

Mount Royal Participants (n=15)

Kwantlen Participants (n=18)

Kwantlen Program Representatives (n=6)

On a scale of 1 to 5, where 1 no need at all, 3 is somewhat of a need, and 5 is major need

How much of a need is there for the PC for IEHPs Course?




teamwork, and patient-centered care. One Kwantlen program representative indicated that ―this kind of course work would be beneficial to anyone‖ as it encourages individuals to carefully assess verbal and non-verbal communication. Two other stakeholders representing Kwantlen argued that language incompetency can significantly limit employment opportunities for IEHPs. They believe that the Course will ―lead to much better work-life quality for IEHPs‖ and that the Course can keep health authorities from having to deal with the responsibility of addressing issues that should have been addressed before IEHPs enter the workplace. Thus, some respondents recommended that the Course should be made a pre-requisite to licensure.

Kwantlen participants reinforced the strong need for the Program, recognizing that the

cultures between their home countries and Canada’s differ greatly and that cultural and communication differences are important to learn before entering the workforce. One respondent reported that they knew nothing about Canadian health care culture before participating in the Course. Appropriate behaviour, mannerisms and communication skills are important in providing proper patient care. A couple of participants also mentioned that learning to communicate properly with coworkers is important to increase the professionalism of patient care.

Mount Royal program representatives and participants provided the following input regarding the need for the Course:

Program representatives indicated that the Course has received positive feedback from its

participants, who emphasized its unique structure and strength in filling a gap between a general ESL course and more professional health care courses. Communication is of vital importance to help IEHPs integrate in the workplace. The Course helps professionals gain important culturally-sensitive skills (e.g. how to deliver bad news – in some cultures the doctors do not deliver bad news to the patients; instead, they speak to the patient’s family).

Alberta, however, experienced somewhat weaker demand for the Program. Mount Royal has not been as successful in filling up the spaces for the April 4 – June 30, 2011 term (have 3 seats currently available). This can be attributed to the late promotion of the spring term (i.e. did not start promoting the Course offered in spring until January), according to program representatives. One respondent indicated that, since this is the first time that the language institute is involved in a government-funded program, IEHPs do not necessarily associate Mount Royal University with this type of course.

Mount Royal past participants, however, reported a great need for this type of programming

in the surveys as well as in the focus group. Most participants noted that they gained needed communication skills and learned appropriate behaviour that will help them better relate with patients in Canada. Many past participants also stressed the usefulness of the Course in gaining an understanding of Canadian culture and applying a patient-centred care approach. Respondents also mentioned having gained effective problem-solving skills as well as cultural sensitivity, improved language skills and confidence in speaking. Several focus group participants indicated feeling more confident dealing with patients. Additionally, many participants reported improving their knowledge of ethics and problem solving skills in a culturally appropriate and professional manner. Lastly, it was noted that the Course offers a great introduction to the Canadian health care system and provides an understanding of what is required before entry into the Canadian health care sector is granted.




The focus group with Mount Royal stakeholders also conveyed a strong need for the Program. One representative of the Bridge to Canadian Nursing (BCN) Program, which is divided into three levels, indicated that the program will no longer be offering LEVEL I: Introduction to Nursing in Canada, which will increase the need for a course such as the PC for IEHPs. Stakeholders also revealed that the feedback received from past participants has been very positive.

2. The results of the literature review indicate that there is an on-going shortage of health

professionals in British Columbia and Alberta as well as other jurisdictions, which is addressed in part through attracting foreign trained health professionals. The shortage of health professionals is a global issue increasing in severity. The Canadian Medical Association stated in 2008 that, although the number of working nurses, pharmacists and dentists in Canada continues to rise, so does the gap between the supply and demand of health professionals. The nursing shortage is projected to grow to 113,000 by 2016 and there are already

2,000 unfilled pharmacist positions across the country2. Some health authorities report having up to 10% of their pharmacist positions vacant, according to the Canadian Pharmacists Association3.

According to the BC Nurses Union, BC is currently short about 2,000 nurses. The shortage is forecast to become even more pronounced, as about one-third of BC’s nurses are eligible to retire in the next five years.4 Furthermore, the total number of jobs in nursing is projected to increase in order to meet rising demand resulting from:

An aging population. The fastest growing segment of the Canadian population is the age

bracket over 85 years; An increase in the acuity of patients in hospitals. The number of people in need of skilled

care from a registered nurse is growing; and The delivery of more health care outside the hospital setting.

As early as 2007, there were predictions of shortages in all health professions. An internal report for the Vancouver Coastal Health Authority stated that, by 2015, widespread staff shortages will occur in about a dozen medical professions, including doctors and nurses. The report forecasts an 85% shortfall in medical laboratory technicians, 75% fewer bedside care aids, and 72% fewer ultrasound technicians. A shortage of hospital pharmacists, radiation technologists, and physical and occupational therapists is also predicted.5

In 2008, the BC Medical Association estimated that 20,000 people in BC were unable to access a family physician on a regular basis. At the same time, the Association estimated that 4,000 Canadian doctors plan to leave active practice in the next two years alone6. The shortage is evidenced by the efforts of the BC Health Authorities to recruit medical professionals. The Vancouver Island Health Authority currently has positions for 68 doctors on its website. The Northern Health Authority has 55 vacancies for physicians. The Vancouver Coastal Health Authority has 229 openings in its system. The BC Government maintains a website to

2 http://www.medicalnewstoday.com/articles/155947.php 3 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2211342/ 4 http://bcnursessolutions.ca/ 5 The Epoch Times, April 2007

6 Physician Retirement in Canada: What Is Known and What Needs to be Done, Raymond W. Pong, PhD Centre for Rural and Northern Health Research, Laurentian University, 2007.

http://www.medicalnewstoday.com/articles/155947.php

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2211342/

http://bcnursessolutions.ca/




recruit health professionals, Health Match BC, the mission of which is to recruit physicians and assist in the recruitment of registered nurses and allied health professionals on behalf of BC's publicly-funded health care facilities. There are 262 job openings for physicians listed7.

The situation is similar in Alberta. In 2008, the College and Association of the Registered Nurse of Alberta indicated that there were 1,400 registered nurse vacancies with an additional 6,000 needed by 20168. There is an estimated shortfall of 1,000 doctors across the province. In Calgary alone, there is an estimated 200,000 people without a family doctor. The city needs at least 150 new doctors, along with another 150 rural doctors in nearby areas9.

Canada is not self-sufficient in producing health professionals and has long relied upon graduates of foreign education programs as a partial solution to meeting health human resource shortages. As of 2006, more than 20,000 licensed practical nurses and registered nurses working in Canada (not including Quebec) had been educated outside Canada. As of 2007, 23% of Canada’s general physicians and specialists were foreign trained.10

Recruitment is both a policy and a practice of individual health authorities as well as the provincial and federal governments. Professional health care workers can enter Canada under various economic immigration programs.

In 2009, approximately 4,400 immigrants obtained permanent residence in Canada and indicated they intended to work as managers or professionals in the health care sector. In addition, in 2009, employers in the health care and social assistance sectors applied for and received Labour Market Opinion (LMO) confirmations from HRSDC that would allow them to hire 3,300 workers under the TFWP11.

3. The type of services offered through the PC for IEHPs Course can help IEHPs overcome

significant barriers associated with lack of professional vocabulary, cultural differences in interacting with and caring for patients, and difficulties associated with obtaining licensure and employment in the Canadian health care field.

When participants were asked to rate the significance of the barriers facing IEHPs, on a scale of 1 to 5, where 1 is not at all significant, 3 is somewhat significant, and 5 is very significant, the majority of both Kwantlen (94%) and Mount Royal (81%) participants provided a rating of 4 or 5, as indicated in the chart on the following page. The average rating provided by Mount Royal participants was 4.4 and the average rating provided by Kwantlen participants was 4.5.

CHART 2: SIGNIFICANCE OF THE BARRIERS FACING IEHPs

7 http://www.healthmatchbc.org/ 8 http://www.newswire.ca/en/releases/archive/December2010/09/c4157.html 9 http://www.thecanadianencyclopedia.com/index.cfm?PgNm=TCE&Params=M1ARTM0013191 10 The Acculturation of Internationally Educated Health Professionals in Canada, Claudia von Zweck and Pamela Burnett.

11 Citizenship and Immigration Canada, Canada Facts and Figures: Immigrant Overview, Permanent and

Temporary Residents, 2009

http://www.healthmatchbc.org/

http://www.newswire.ca/en/releases/archive/December2010/09/c4157.html

http://www.thecanadianencyclopedia.com/index.cfm?PgNm=TCE&Params=M1ARTM0013191




Most past participants from Mount Royal recognized lack of vocabulary related to health as a major barrier. Some respondents specified that, due to their lack of English fluency and familiarity with Canadian expressions, their interactions with patients were limited. As a result, IEHPs are hesitant to speak English with others and have low self-confidence. In addition to English language barriers, almost half of the respondents identified cultural differences, such as difficulty in learning the ―Canadian way‖ of working with patients, as a major barrier. A few Mount Royal participants also identified significant differences between appropriate communication styles in interacting with patients in Canada and patients in their home countries. These respondents noted that they needed to learn Canadian ways of communicating but that they misunderstood or were not privy to Canadian professional standards of communication prior to participating in the Course. Another major barrier, for over half of the past Mount Royal participants, is the process in obtaining a professional job in their field. Respondents noted the difficulty in obtaining work experience and professional references in order to gain required licensing to enter a job in their field. Lack of professional assistance and the high fees associated with licensing exams were reported by a couple of respondents as reasons why they had not yet applied for licensure.

Current and past Kwantlen participants also identified differences in culture and lack of language fluency as major barriers. Learning English and being able to pass exams such as the Test of English as a Foreign Language (TOEFL) or International English Language Training System (IELTS) were recognized by respondents as professional barriers. In addition, the cultural differences was identified as a barrier to solving patients problems, being understood and understanding the Canadian health care system. One respondent identified unequal treatment towards IEHPs as a barrier to gaining employment. A few past Kwantlen participants stressed the lack of residency training positions available and the lack of options other than residency training to resume a medical career.

4. While there are other programs and resources targeted at foreign trained health professionals, the PC for IEHPs Course fills a unique niche within British Columbia and Alberta.

0%

0%

19%

25%

56%

0%

6%

0%

33%

61%

0% 20% 40% 60% 80%

Not at all significant

2

Somewhat significant

4

Very significant

How significant do you think are the barriers facing IEHPs?






Given an increasing reliance on attracting foreign workers as a key strategy to ease current and projected labour shortages, a variety of education programs and resources designed to assist foreign trained health professionals further develop their language skills and adapt to the local work environment have been developed. Appendix VI provides examples of other programs and resources available in Canada and in other jurisdictions to assist foreign trained health professionals. As part of the review, several programs available in BC in AB were identified including:

The Vancouver Medical English Institute, which targets medical professionals with intermediate level English skills. Medical professionals should be at an upper intermediate level, equivalent to 550 TOEFL. Accepted CELBAN scores are: Speaking CLB 8; Listening CLB 9; Reading CLB 8; Writing CLB 7. All Medical English courses are limited to a maximum of eight students per class.

The Orientation to the Canadian Health Care System, Culture and Context program, which is a 30-hour, online course available through various universities in Canada.

The Medical Communication Assessment Project (MCAP), which is a 12-week course

(including a full-time 4 week clinical placement component and an 8 week instructional component) offered to immigrant medical graduates who are Canadian citizens or permanent residents and have passed the Medical Council of Canada Evaluating Examination (MCCEE) and Medical Council of Canada Qualifying Examination Part I (MCCQE1) exams by the University of Calgary and the University of Alberta. A total of 20 participants are selected per intake. The design of the PC for IEHPs Course was modeled, in part, after the MCAP.

A review of the literature indicates that approaches to design and delivery vary from program to program, reflecting local needs and specific target groups. That being said, many of these programs and resources share common characteristics including: The primary goals are to enhance employability and facilitate the transition of foreign trained

health professionals into the workplace by improving their career-specific language competency and preparing them for licensing exams and continuing studies.

The language training is tailored to the profession(s). Unlike more general forms of language training, the primary focus is on the application of language skills in the area of medicine and healthcare and only secondly on the further development of language skills including grammar and structure. As one review noted, ―the traditional approach to English language training has done well to meet the needs of non-professional students. Today's global economy requires career-specific language that includes workplace culture and jargon for safe, effective delivery of professional services‖12.

Entry requirements with respect to general language competency tend to be relatively advanced so that the focus of the training can be contextual-based and experiential. Towards that end, programs may incorporate simulations or even clinical components, with students working with patients under direct supervision of the physician. Simulations are scenario-

12 Melodie Hull, Changing The Paradigm For Medical English Language Teaching. Paper presented at the 2004 International Symposium of English for Medical Purposes, Xi'an, China. http://www.usingenglish.com/teachers/articles/changing-paradigm-for-medical-english-language-teaching.html

http://www.usingenglish.com/teachers/articles/changing-paradigm-for-medical-english-language-teaching.html




based, taking student learners through different stages from initial patient interviews to the delivery of bad news to specific patient types.

The focus is often not on increasing performance on standardized language tests, recognizing that such tests are not necessarily an effective measure of the progress made.

Program leaders (instructors, teachers, tutors and/or guest speakers) include both health professionals as well as language instructors.

Elements of the program (or in some cases, all components) are delivered online.

Programs may focus on various elements that make up effective communication including active listening, verbal communication, non-verbal communication, voice management, and cultural awareness.

Although the PC for IEHPs Course shares some similar characteristics with the other programs identified, a review of the design and resources indicates that it tends to be unique from most others in terms of its length, targeting of a wide range of medical professions (many focus on particular professions such as physician or pharmacist), extensive use of a performance-based approach, and somewhat larger class sizes (some programs are limited to 6 or 8 participants).

B. COURSE DESIGN AND DELIVERY The following section summarizes the findings of the field research with respect to the design and delivery of the PC for IEHPs Course. The findings are as follows:

1. The Course, particularly its curriculum, is considered to be well designed given the needs

of IEHPs in both regions. The core strength of the curriculum is its focus on the performance-based model.

The PC for IEHPs Course was developed in response to the need to help IEHPs improve their English language skills for working in a health workplace. To date, 119 IEHPs completed the Program (90 at Kwantlen and 29 at Mount Royal) and 29 are currently participating. To date, the Course has been delivered:

In British Columbia: 6 times Pilot 1: January 5 - April 17, 2009; 15 participants enrolled and 14 completed Pilot 2: September 8 - December 18, 2009; 14 participants enrolled and 12

completed Course 1: March 1 – June 11, 2010; 14 participants Course 2: March 29 – July 16, 2010; 16 participants Course 3: September 7 – December 17, 2010; 17 participants Course 4: January 4 - April 15, 2011; 17 participants Course 5: May 2 – August 12, 2011; 18 participants

In Alberta: 2 times

Pilot 1: March 29 - June 29, 2010; 12 participants Course 1: August 30 - November 29, 2010; 17 participants Course 2: April 4 – June 30, 2011; 12 participants




Unlike traditional ESL students, IEHPs who already have general language proficiency (i.e. CLB 7) in English and clinical expertise require an unconventional approach to instruction. In the PC for IEHPs Course, participants learn to communicate with patients using a performance-based curriculum model which permits for direct, immediate feedback in practice scenarios and enables them to internalize language as behaviour. The curriculum design utilizes a performance-based approach to instruction which places priority on: communication practice (language and behaviour) of role-plays: clients, families and health

teams; language as behaviour; coaching of role-plays; filming of rehearsed and unrehearsed role-plays; use of standardized patients/actors; and immediate feedback and self-reflection.

The BC version of the Course, including the curriculum, materials and assessment process, was adapted to the Alberta context. For example, the 15-week, BC-developed curriculum was reduced to 13 weeks. Other major differences pertaining to the curriculum, delivery, materials and language assessment process are summarized in the following table.

TABLE 5: PROGRAM DELIVERY & ASSESSMENT METHODS

Areas of the Course

Kwantlen – BC Mount Royal - Alberta

Delivery 15 weeks (4 hr/day x 5 days/week) 13 weeks (4 hr/day x 5 days/week)

300 hrs of instruction 260 hrs of instruction

Materials and

Curriculum

Calgary Cambridge guides: Medial Communication Process Skills framework

Calgary Cambridge guides: Medial Communication Process Skills framework

Filmed performances take place in a regular classroom

Filmed performances take place in the School of Nursing lab

Instructor Manual Instructor Manual

Student workbook, weekly handout materials, and performance logs

Student workbook, weekly handout materials, and performance logs

Learning Management System (LMS) – Moodle is used for posting filming of role rehearsal for review and feedback; homework assignments posted by instructor; readings & reference material; video of communication models to be used as reference; and a discussion board which is currently in the development process.

E-learning platform, Blackboard course site: The use of the site was extended to provide supplementary materials storage and external links to additional reading resources and websites, to assess writing assignments, and to post reading assignments, relevant news articles, and course announcements.

Standardized Patient materials 7 standardized patients

Simulation Patient materials A reduction in the number of Simulation

Patients from 7 to 5

Simulated Medical Scenarios & Role Rehearsals

Simulated Medical Scenarios& Role Rehearsals

The U of T Orientation to the Canadian Healthcare System, Culture and Context as a pre-course reading assignment. Workbooks are distributed to participants prior to the start of each Course.

MRU integrates the U of T course throughout the curriculum as reading and writing assignments and for HP consultant-led discussion activities.




Areas of the Course

Kwantlen – BC Mount Royal - Alberta

'Week at Glance' template 'Week at Glance' template

Addition of rehearsed filmed performance observation. Film performances take place in a Nursing lab, students are provided with scenarios varying slightly depending on the health profession

A discussion board will be added in 2011 and will be used to facilitate alternative tasks during filming. The Health Professional Consultant may also use the site to post information

Strong focus on performance based instruction – not all the curriculum’s ESL materials are being used

Addition of a Course Orientation, which is delivered in Week 1 of the curriculum

Other adaptation of materials (i.e. changing references to BC to AB in the role rehearsal scenarios and in the ESL materials (e.g. place names), and BC Health internet links to AB Health Services links)

Students Assessment

Adaptation of the Institutional Canadian English Language Benchmark Assessment for Nurses (CELBAN)

Adaptation of the Institutional Canadian English Language Benchmark Assessment for Nurses (CELBAN)

Tests on the reading assignments Tests on the reading assignments

Written feedback from a peer group Feedback by the Language Instructor,

Clinical Educator, and Standardized Patients throughout the Course

Written feedback from a peer group Feedback by the Language Instructor,

Health Professional Consultant, and Simulation Patients (oral feedback from SPs immediately following their filmed performances)

Students are awarded a certificate at the end of the Course

Students are awarded a certificate at the end of the Course

Program coordinator devised an assessment method based on attendance and the timely submission of e-portfolio assignments consisting of writing and reading tasks, weekly performance etc. Portfolios are submitted at mid-term for feedback and at the end-of-term for evaluation.

Program participants and representatives from both institutes were asked to rate a series of statements related to the Course curriculum, design and assessment, on a scale of 1 to 5, where 1 is strongly disagree, 2 is somewhat disagree, 3 is neither agree nor disagree, 4 is somewhat agree and 5 is strongly agree. As illustrated in the chart on the following page, most participants and representatives agreed that the curriculum is well designed and appropriate for participants. Kwantlen participants largely agreed that the curriculum was tailored to their specific needs as IEHPs, such as learning soft skills using a patient-care approach. Some Mount Royal participants agreed that changes made to the curriculum better address the needs of doctors while others felt that some curriculum improvements are still needed, particularly with regards to the scenarios, in




order to make it flexible enough to meet the needs of various participants (doctors, midwives, and nurses). Representatives of Mount Royal noted that the curriculum is effective because of its performance-based focus. A few respondents suggested that the curriculum could be improved to better meet the needs of all participants (e.g. midwives).

Program representatives also strongly agree that the Course is well-designed to meet the language and professional needs of newcomers it services. Mount Royal representatives rated the statement at the average of 4.3 adding that the curriculum was effective because of its performance-based focus, where participants can practice communication and behavioural skills instead of just observing the interviews. Participants use video technology to practice role playing and use simulated patients in an appropriate, clinical setting. Kwantlen representatives also strongly agreed (average of 4.7) that the Course is well-designed to meet the language and professional needs of the newcomers it serves. The representatives noted that although the Course is well designed to meet the language needs of the participants; professional needs are more difficult to meet as they vary depending of the profession (e.g. dentists) and the background of the participant.

CHART 3: CURRICULUM DESIGN AND APPROPRIATENESS FOR IEHPs

When asked whether the assessment processes are well designed and appropriate for participants Kwantlen representatives generally agreed (average of 4.3). A few representatives noted that institutional CELBAN may not be appropriate for all professions; however, CELBAN continues to be relevant in addressing communicational competencies for all professionals because they all work with patients. Mount Royal representatives also generally agreed with the statement (average of 4.7) but noted that there could be more clear expectations and they could increase the marking systems to better measure the improvements (from 8 to 10).

2. Kwantlen has been particularly successful in promoting the Course and attracting the type of participants who would benefit from it. The target group for the Course is IEHPs who: Have an international degree in their health professions;

4.1

4.3

4.3

4.7

1 2 3 4 5





On a scale of 1 to 5, where 1 is strongly disagree, 2 somewhat disagree, 3 neither agree nor disagree, 4 somewhat agree and 5 strongly agree

The curriculum is well designed and appropriate for participants




Have international professional work experience in their field and/or as college or university teachers in academics (some participants may be recent graduates with minimal professional work experience);

Have recently arrived in Canada or have been in Canada for a period ranging from several months to several years or more;

May be employed in the health care sector; May be unemployed or working in ―survival‖ jobs, or may be full-time homemakers; May already have started the licensing process; May have met or have not met fluency requirements for licensing or for admission to bridging

programs; and Want to increase their language skills in order to meet fluency requirements and be able to

work successfully in Canada.

The priority client groups for the PC for IEHPs Course are a mix of IEHPs from the following professions: nursing; physicians; midwifery; pharmacy; physiotherapy; and occupational therapy. The eligible participants must meet the language requirements measured by CLB, TOFEL or IELTS. Some differences and similarities of the Course eligibility requirements are summarized in the following table:

TABLE 6: ELIGIBILITY, RECRUITMENT AND PROMOTION STRATEGIES

Areas of the Course

Kwantlen - BC Mount Royal - Alberta

Entrance Eligibility

Minimum CLB score of 7 in Reading, Writing, Speaking, and Listening

Canadian Language Benchmarks (CLB) with a score of 7 in Speaking and Listening and 6 in Reading, OR IELTS Academic overall 6 with 6 in Speaking and Listening, OR TOEFL iBT 80 with 18 in Speaking

Canadian citizens or landed immigrants

Permanent residents of Alberta

Current Recruitment

and Promotion Strategies

Promotional efforts include: Emailing and liaising with Health Skills

Connect providers, Health Regulatory Organizations, Bridging Programs, community organizations, and educational institutions

Industry organizations are sent brochures

Word-of-mouth has been effective (e.g. participants come in with friends etc.)

Promotional efforts include holding presentations about the program, distributing paper-based materials, sits visits and liaising with community stakeholders and relevant organizations, sitting at partner organization committees; and maintaining strong relationships with the nursing faculty, bridging programs, etc

A waitlist for the upcoming Course offerings has recently started

The profile of participants that completed Pilot 1 and 2 at Kwantlen, and a Pilot at Mount Royal from March 29 to June 29, as well as the profile of past and present participants interviewed as part of this evaluation are presented in table 7 on the following page.



Evaluation of the IEHP Course Page 22

TABLE 7: PROFILE OF PARTICIPANTS

Profile of the Participants

BC – Kwantlen Alberta - Mount Royal

Pilot 1 (n=15) Pilot 2 (n=14) Interviewed (n=19) Pilot (n=12) Interviewed (n=16)

Time Jan 5 to Apr 17, 2009 Sept 8 to Dec 18, 2009

January – April, 2011 (n=11)

March 29 to June 29, 2010

August 30 - November 29, 2010 (n=8)

Pilot 2: September – December, 2009 (n=6) March 29 - June 29, 2010

(n=8) Pilot 1: January – April, 2009 (n=2)

Profession

7 Physicians

5 Nurses

2 Pharmacists

1 Occupational Therapist

5 Nurses

4 Pharmacists

3 Physicians

1 Midwife

1 Physiotherapist

9 Physicians

7 Nurses

2 Pharmacists

1 Midwife

8 Physicians

4 Nurses

9 Physicians

6 Nurses

1 Pharmacist

Length of Time in Canada

< 1 year: 2 participants

1 to 5 years: 9 participants


< 1 year: 1 participant


6 to 9 years: 1 participant

> 10 years: 2 participants

Unknown: 1 participant



6 to 9 years: 1 participant

> 10 years: 1 participant

Information not available




Country of Birth Information not available Information not available

China— 6

Iran— 3

India— 2

Turkey—2 One IEHP from each of the following countries: Chile, Iraq, Fiji, Russia, South Korea, Philippines

Columbia— 4

Pakistan— 2 One IEHP from each of the following countries: Afghanistan, Egypt, Iran, Japan, Nigeria, Poland

Columbia— 2

Japan— 2

Pakistan— 2 One IEHP from each of the following countries: Afghanistan, China, Egypt, Hong Kong, Iran, Poland, Syria, Taiwan, Ukraine, Venezuela.

Employment Status (Participants Reporting)

5 employed in health care profession

4 employed in non- health care

7 unemployed


9 unemployed


3 employed in non- health care profession or causally

10 unemployed


5 employed in non health care profession

4 unemployed


6 employed in non health care profession or casually participants

8 unemployed


SUMMARY OF DATA FROM PRIMARY SOURCES


Program representatives were asked to rate the two statements, outlined in the following chart, related to Program promotion and recruitment of participants, on a scale of 1 to 5, where 1 is strongly disagree, 2 somewhat disagree, 3 neither agree nor disagree, 4 somewhat agree and 5 strongly agree. As indicated in the chart, program representatives from both institutions believe that the efforts to promote the Course and attract appropriate students who would benefit from the Course have been successful.

CHART 4: PROGRAM PROMOTION

Kwantlen program representatives noted that promotion activities have been successful in attracting IEHPs who are qualified and interested in continuing their professional development. One respondent noted that there are currently not enough seats for all IEHPs who are qualified to take the Course and that consideration should be given to expanding the Course. When asked how they first heard about the Course, the majority of participants from Kwantlen (72%) said that they were referred to the Program by another organization. Others indicated finding out about the Course through referral by a friend or family member (17%), through the internet (6%) or through other means (6%) such as referral by an instructor at the university. Mount Royal representatives noted that the efforts to recruit professionals who are a good fit for the Program have been successful (e.g. the coordinator spent a considerable amount of time screening potential participants). Although various advertising and promotion activities (including Mount Royal websites, brochures, site visits, partnership links, partner organization committees, nursing faculty and other stakeholders) were used to promote the Course, program representatives noted that promotion could be improved to attract all types of professions such as occupational therapists and physiotherapists. The focus group with other Mount Royal stakeholders also conveyed that most advertising is currently done in-house through various bridging programs and the School of Nursing. Stakeholders suggested that, in order to increase Course enrolment and target a wider audience, Mount Royal should expand its networks and advertise externally through various means, such community churches, the Calgary Immigration Society, cultural groups, associations (e.g. College & Association of Registered Nurses of Alberta), and cultural newspapers for immigrants. When asked how they first heard about the

4.3

4.0

5.0

5.0

1 2 3 4 5

The efforts to promote the PC for IEHPs havebeen adequate and effective

The course has been successful in attractingthe type of students who would benefit from

these types of services

On a scale of 1 to 5, where 1 is strongly disagree, 2 somewhat disagree, 3 neither agree nor disagree, 4 somewhat agree and 5 strongly agree.

Average Ratings

Kwantlen Program Representatives

Mount Royal Program Representatives

N=6

N=4

N=6

N=4

http://www.nurses.ab.ca/





Course, about a half (50%) of participants from Mount Royal said that they were referred to the Program by another organization. Others found out about the Course through reading a brochure or other print literature (13%), through referral by a friend or family member (13%) or through referral by another Course participant (6%).

3. The Course has provided sufficient support to instructors to ensure that they are well-prepared to deliver the Course. The review of pilot programs in both institutions has shown that the inclusion of the standardized patients and clinical instructors in the delivery of the Course has significantly contributed to its effectiveness. Participants were satisfied with the language support and feedback received from their language instructors. They found clinical instructors and guest speakers particularly useful in helping them understand the Canadian health care system as well as important issues related to their profession. Guest speakers were scheduled, based on their availability, anytime during the Course (particularly in the last half). Different topics, such as mental health, addiction, homelessness, chronic disease, elder care, Aboriginal health, and mental/physical disabilities, were included. Participants were asked to do research and background reading prior to the day of the guest speaker. During the guest speaker sessions, class instructors take the role of an observer, take notes, provide participants with feedback, and facilitate a discussion to reflect on the experience.

TABLE 8: PROGRAM STAFFING

Areas of the Course


Staffing

Pilot programs had 2 language instructors, 1 clinical educator and 7 standardized patients

Pilot offering had 2 language instructors, 1 health professional consultant and 5 simulation patients

Currently, there is 1 FTE language instructor (2 alternating instructors), 1 clinical educator, 1 standardized patient coordinator, and 7 standardized patients (40 hrs/semester)

Currently, there is 1 FTE language instructor, 1 health professional consultant (8hrs/week), and 5 simulation patients

Instructors to Student Ratio

Pilots had 14 to 1 and 12 to 1 student-to-instructor ratios

Pilot had a 12 to 1 student-to-instructor ratio

A 17 to 1 FTE student-to-teacher ratio is currently in place

A 12 to 1 FTE student-to-teacher ratio is currently in place




Areas of the Course


Instructors Background

During the Pilot, language instructors were selected based on the following criteria: Minimum of 2 years experience

teaching language to learners in combined skills or English for Specific Purposes programs (experience teaching language learners at CLB 6-9 levels , teaching language in a health care context, teaching a multilevel group)

Computer literate and comfortable using Moodle and Windows Media Player or equivalent.

Comfortable with using a performance based approach including: experience with videotaping and providing feedback on role rehearsals

Requirements for hiring a language instructor included: ESL instructor who has experience

teaching adults Has interest in adopting a different

kind of teaching methodology (i.e. willing to try new performance based technology and be trainers instead of teachers)

Clinical educators were selected based on their currency of practice and experience working in interdisciplinary teams

The health professional consultant was selected based on knowledge and experience of the Alberta healthcare system and current practices, cultural sensitivity and awareness of issues related to IEHPs.

No selection criteria regarding SPs were provided

The stimulation patients used in the Pilot Course were three professional actors with experience with the University of Calgary, Faculty of Medicine; Standardized Patient Program, one ESL Instructor and one second year MRU Bachelor of Nursing student.

Instructor Support

During the pilot, instructors attended an orientation workshop on performance-based methodology based on the M-CAP program experience. Instructors observe and co-teach before teaching the Course themselves.

During the Pilots, the clinical educator participated in the Course twice a week, providing feedback in the Role Rehearsal related to Canadian clinical practice.

During the pilot, the program coordinator and instructors attended an orientation workshop (7 hours) on performance-based methodology based on the M-CAP program experience. The instructors were observed in Week 11 of the course (June 7 and 8) by Dr Watt and Deidre Lake who provided them with feedback to refine their teaching techniques.

Informal meetings between faculty members and the Business Manager, Faculty of Academic & Career Advancement are currently held, as needed, to review what is working, what changes are needed

The program coordinator and instructors were trained as Institutional CELBAN assessors and administrators

Course instructors report back to the Manager of Languages Institute and occasionally debrief with the Program coordinator




Program representatives and participants from Mount Royal and Kwantlen generally agreed that the instructors have the qualification necessary to deliver the Course and that between 10 to 15 students per instructor is an optimal ratio. The instructors are considered to be well-qualified to teach ESL to highly educated health professionals, have a good teaching methodology, clear pronunciation and good classroom skills. Participants also agreed that the instructors were engaging, attentive to individual questions and emphasized students-centered learning. A few respondents from both regions somewhat disagreed, noting that instructors should be better prepared for class and have better knowledge of the Canadian health care system. As illustrated in the following chart, most representatives and participants interviewed strongly agreed that instructors have the qualification necessary to deliver the Course and that the instructor-to-student ratio is appropriate. IEHPs at Mount Royal who participated in the Pilot were somewhat more satisfied with the student to instructor ratio (12-to-1 student to instructor ratio) than those participating in the fall term (17-to-1 student to instructor ratio).

CHART 5: INSTRUCTOR QUALIFICATION AND INSTRUCTOR-TO-STUDENT RATIO

Some representatives suggested that the opportunity for instructors to observe and be mentored by more experienced instructor was effective in helping them understand the performance-based framework in which the class operates.

4. Overall, the Course is considered to be well structured and successfully implemented in

both regions. Kwantlen program representatives all agreed that the Course has been implemented as planned, while 2 out of 4 representatives from Mount Royal said that some changes were made before

4.7

4.5

4.4

4.6

5.0

4.0

5.0

4.5

1 2 3 4 5

Instructors have thequalifications necessary to

deliver the course

The instructor-to-studentratio is appropriate


Average Ratings

Mount Royal Program Representatives

Kwantlen Program Representatives

Mount Roal Participants

Kwantlen Participants

N=4

N=6

N=16

N=17

N=4

N=6

N=16

N=18




implementing the Course. Representatives from both regions agreed that good adjustments to the design have been made over time to improve the flexibility of the structure in order to better meet the needs of IEHPs. As described in the following table, appropriate locations have been selected to deliver the Course and suitable technical requirements have been provided.

TABLE 9: LOCATION, TECHNICAL & OTHER SUPPORTS

Areas of the Course Kwantlen - BC Mount Royal - Alberta

Location

Kwantlen Polytechnic University Surrey, BC Canada

Mount Royal University Calgary, AB, Canada

Regular classroom and computer lab

Regular classroom, School of Nursing laboratory, and computer lab

Technical and Other Supports

Use of Learning Management System (LMS) – Moodle

Use of the e-learning platform, Blackboard Course site

The computer lab School of Nursing Laboratory

Video camera Video camera

Instructors converted the Role Rehearsal (RR) files to Windows Media Video (WMV)

Audio-video resources at the School of Nursing Library. Participants can use a ―smart lab‖ to get technical issues fixed

Mount Royal program representatives agreed that the location is appropriate because it is conveniently located close to resources such as the library, nursing lab, computers, a video and a projection unit. One respondent mentioned that the convenience of having accessible computers nearby is of great benefit to them in being able to easily research career-related materials. Mount Royal participants noted that the lab setting makes working with simulation patients feel more real, so they are more emotionally engaged and motivated to learn. A few participants from both regions would prefer to have the Course, or some classes, delivered in a clinic or hospital. Kwantlen program representatives, although largely agreeing with the statement, also suggested that expanding the Course to include other locations (such as Richmond and Vancouver) would be more convenient for participants. A few Kwantlen participants also indicated that they would prefer if the Course was offered at other locations, such as New Westminister, Langley, Vancouver or North Vancouver. The chart on the following page presents the average ratings for all groups.

CHART 6: PROGRAM LOCATION

3.4

4.2

4.5

4.8

1 2 3 4 5






The course is delivered in the appropriate location




Overall, program representatives in both regions generally agreed that the structure of the Course is flexible enough to respond to individual needs and that the location, classroom and technical requirements provided are adequate. Mount Royal representatives (average rating of 4.0) noted that there is excellent IT support in terms of audio-video resources at the university, which is very valuable for the online aspect of the Course. Kwantlen representatives (average rating of 4.5) also largely agreed with the statement; however one respondent noted that the design of the Course does not allow for much flexibility and in terms of content, there is a gap between what is included and what is needed. For example, there is a need for Canadian health professionals to understand the unique experiences of children or patients with substance abuse issues, as well as other particular patient groups that the IEHPs will potentially serve.

5. Appropriate monitoring and reporting strategies are important in making continuous adjustments to the Course as necessary and increasing level of support, including financial support from the program partners. Both Kwantlen and Mount Royal developed various monitoring and evaluation strategies to support reporting and future development of the Course. The instructors gather feedback from the participants at the midterm and end of term about their satisfaction with the Course. In addition, participants’ language scores as well as the instructors’ reflections on different aspects of the Course are summarized at the end of each term, helping to generate reports to the funders and other partners. Monitoring and reporting strategies as well as current funding structures are described in the following table.

TABLE 10: MONITORING, REPORTING, AND FUNDING STRUCTURE


Course monitoring and evaluation

Midterm and end of term surveys of participants

Midterm and end of term surveys of participants

CELBAN scores CELBAN scores

Instructors reflection of the Course Instructor Questionnaires

End of term participant interviews with the Program Coordinator

Follow-up survey of participants (6-8 weeks following Course completion)

Reporting

Current reporting requirements include an End-of term Evaluation (as part of the funding requirements)

Current reporting requirements include an End-of term report and a final year-end report to the funders

Funding structure

Delivery cost per participant is approximately $5,241

Delivery cost per participant is approximately $5,000

Service Canada through Employment Skills Access Funding

CIC provides funding for up to 10 seats for permanent residents and for 63% of the program coordinator salary

Eligibility requires the following criteria:

Unemployed not receiving employment insurance benefits

have not received employment insurance

benefits in the past three years

have not received

Eligibility for funding: permanent residents of Alberta





maternity/parental benefits in the past five years

Students pay no tuition fees MRU is starting to charge tuition fees of $1,900 in 2011 ($3,300 for international students)

Program representatives from Kwantlen mostly agreed with the statement that the Course is cost- effective. Respondents noted that, although the program may be expensive, it is cost-effective given the services it offers, the benefits it generates and the importance of each program component for the long term outcomes. Mount Royal representatives noted that a

professional program such as the PC for IEHPs is expensive to stage; however, they noted that some cost-savings could be achieved by introducing on-line components for the aspects of the program that do not include inter-personal communication. Mount Royal introduced student fees to cover some of the cost of the Course. As illustrated in the following chart, program representatives from both institutions believe that the monitoring and reporting mechanisms are appropriate.

CHART 7: MONITORING AND REPORTING MECHANISMS

AND COST-EFFECTIVENESS

C. ACHIEVEMENT OF IMPACTS AND OBJECTIVES The major findings regarding the success of the PC for IEHPs Course in generating its intended impacts and achieving its objectives are as follows: 1. The most significant impact the Course has had on participants is improving their

English language competency specific to the health care sector and their communication skills. Language proficiency scores, as measured by tests such as CELBAN, Canadian Language Benchmarks Assessment (CLBA), and Enhanced Language Training Placement Assessment

5.0

3.3

4.8

4.8

1 2 3 4 5

The monitoring and reporting mechanisms for thePC for IEHPs are appropriate

The Program is a cost-effective way of deliveringthese types of services


Average Ratings

Kwantlen Program Reps Mount Royal Program Reps

N=4

N=4

N=3

N=2




(ELTPA) at the start and end of the Course show that the English language speaking, listening and reading skills of participants have improved. Of the participants in the: Kwantlen Pilot 1, 80% improved one or more of their CLB scores by one or more levels

(out of 15 participants 8 improved their speaking scores by one level one by two levels and 4 improved their listening scores by one CLB level and 3 by two levels). In Pilot 2, 85% of the participants improved one or more of their CLB scores by one or more levels (out of 14 participants 8 improved their speaking scores by one level, 7 improved their writing levels by one level and two by 2 levels, and 7 improved their reading scores by one level, one by two levels and one by three levels).

Mount Royal Pilot, 75% increased their listening skills (including 45% by one benchmark

and 27% by two benchmarks) and 64% increased their reading skills (27% by one level and 36% by two levels).

Program representatives and participants were asked to rate the impact of the Course in the areas of improving participant English language competency specific to the health care sector, on a scale of 1 to 5, where 1 is no impact at all, 3 is somewhat of an impact and 5 is major impact. The average ratings are provided in the chart below.

CHART 8: IMPROVING IEHPs’ COMPETENCY IN THE HEALTH CARE SECTOR

Course participants from both institutes noted that they learned vocabulary, phrases and expressions used in various health care professions that they would be very unlikely to learn in a regular ESL class. They also noted that the Course has increased their language proficiency with respect to: Knowledge and understanding of medical terminology relevant to their work as well as

appropriate vocabulary in communicating with patients versus other professionals. They

3.9

4.5

4.7

5.0

1 2 3 4 5





On a scale of 1 to 5, where 1 is no impact, 3 is somewhat of an impact, and 5 is major impact

Improving participants' competency specific to the health care sector




learned how to use appropriate terminology to ask patients about their concerns and to express support or empathy.

Listening skills by exposing them to different terms and expressions from colleagues and instructors. The Course also provided them with the opportunity to listen to native speakers describing medical conditions using everyday language and to practice in simulated real life situations.

Writing, particularly for participants who had no previous training on how to counsel patients, write reports and summaries, or communicate with other professionals and patients via email. The feedback provided by clinical advisors and standardized patients was considered useful.

Past participants from Mount Royal added that the PC for IEHPs Course enabled them to use appropriate language in professional communication as well as appropriate body language. Program representatives emphasized the Course’s importance in teaching IEHPs aspects of English language needed in the health care workplace that they would not be able to learn anywhere else. Other stakeholders representing Kwantlen stressed that the impacts of the Course are not only illustrated through the pre- and post-measures using the institutional CELBAN scores, but also through the subjective data/self-reflection from the participants themselves.

2. In addition to improving English skills in the workplace context, the Course has helped

participants to better understand the professional culture and expected behaviours in the health care system and to better prepare them to enter bridging programs, take competency exams and apply for licensure. Taken together, these impacts have enhanced the participants' likelihood of obtaining or retaining a job in health care sector. Program representatives and participants in both regions were asked to rate the impact of the Course in several areas, on a scale of 1 to 5 where 1 is no impact at all, 3 somewhat of an impact and 5 is a major impact. Most said that the Course has at least somewhat of an impact (the average ratings for each group are presented in the chart on the following page). In addition to improving participant language skills, the program is considered to play an important role in supporting IEHPs to pursue their careers in health sector by: Heightening their understanding of culturally expected behaviours and the

professional culture of the Canadian health care system. Most representatives and participants in both regions believe that the Course has a major impact in helping participants understand cultural appropriate behaviours in a professional health care setting. Participants suggested that the real-life scenarios offered throughout the Course thought them about the patient-centered care approach, conflict resolution, appropriate body language, and how to be assertive in a respectful way. Participants also talked about the cultural differences in showing empathy, offering support and interacting with patients in Canada and their home countries. Mount Royal participants noted that they gained a better understanding of Canadian multiculturalism and what it means in terms of behaviours and communication practices within Canada’s health care system. During the focus group, past participants also noted the value of learning about Canada’s patient-centre care approach and interactions with patients, including the importance of developing a clear understanding of patient needs and expectations, and issues such as clarifying patient name, asking how patients would like to be addressed and repeating information provided by patients to verify mutual understanding.




Preparing them to enter a refresher/bridging program, take a competency exam,

and apply for or obtain licensure. Participants generally indicated feeling more confident taking exams such as the OSCE exam and the MCC: Nursing Entrance Testing, necessary to enter their professions. Participants provided the following feedback on the importance of the Course in helping them to:

Take competency exams. Over half (63%) of Mount Royal participants had taken

competency exams and found the Course to be important (3.9) in preparing them for the exams. The exams reported include the Substantially Equivalent Competence (SEC) assessment, CELBAN, Canadian Registered Nurse Exam (CRNE), International English Language Training (IELT) and Test of English as a Foreign Language (TOEFL). Many reported learning vocabulary and language skills which helped them pass the exams. The instructors were praised for encouraging the participants to work on their weakness and motivating them to take the exams. Two current program participants at Kwantlen, who have taken a competency exam, noted that the Course has been somewhat important (average of 3.0) in preparing them for the exam. Of the 8 past Kwantlen participants, 5 have taken a competency exam.

Apply for or obtain licensure. Two past participants of Mount Royal had applied for or obtained licensure, both noted that the Course was important in preparing them for this step. One respondent reported passing the exam and becoming a registered nurse. Of the 8 past Kwantlen participants, 5 have applied for or obtained licensure. Enter a refresher/bridging program. The refresher/bridging programs entered by Mount Royal participants included the International Bridge to Canadian Nursing (4 respondents), Pharmacy Bridging Program (1 respondent), and the Medical Communication Assessment Project (1 respondent). A few respondents were taking university courses part-time and others have attended exam preparation classes (e.g. preparing for MCCQE, MCCQE2, EE, OSCE and CRNE exams) or study groups. Participants indicated that the Course helped them be better prepared for these programs by improving their vocabulary and communication skills as well as encouraging them to enrol. No current Kwantlen participants have yet entered refresher/bridging programs. Of the 8 past Kwantlen participants, 3 have entered into a refresher/bridging program.

As illustrated in the chart on the following page, participants and respondents from both regions generally believe that the Course had at least somewhat increased participants’ likelihood of obtaining/retaining a job in the health care sector. Mount Royal program representatives indicated that participants reported having greater confidence in seeking employment within their professional fields. Some participants have gained employment in positions related to their occupations, including a pharmacist who became a pharmaceutical technologist.

Since completing the Course, some Mount Royal participants have taken positions that could help further their professional careers (e.g. participating in a Medical Communication Assessment Project, starting an ―observership‖ with a hospitalist, and becoming a preceptor for a student health care aide). A few were less optimistic about their job prospects, noting that it is difficult to get an entry position. Representatives from Kwantlen also noted that current participants are facing a difficult job market in the healthcare sector.




Many Kwantlen representatives had difficulty providing ratings due to the fact that they did not keep formal track of past participants after completion of the Course. They were aware of some internationally-educated nurses who have completed the CELBAN or other language assessments. The participants reported a few other positive impacts of the Course, such as opportunities to make new friends and learn about various health practices and perspectives in other cultures, which they believe will help them to better understand their patients’ perspectives on health. One respondent said a negative impact was that she had to quit her part-time job to take the Course.

CHART 9: SUCCESS IN ENTERING REFERSHER/BRIDGING PROGRAMS,

HEIGHTENING UNDERSTANDING, AND INCREASING LIKELIHOOD OF OBTAINING EMPLOYMENT

A few representatives noted that the Course had some positive unintended impacts, including facilitating the professional development of the course instructors. The Course has increased instructor awareness and understanding of performance-based technique and its effectiveness in teaching. The Course has also been successful in increasing its profile both provincially and nationally (e.g., agencies are increasingly referring medically-trained IEHPs to the program).

3. The Course has been successful in achieving its objectives as evidenced by the impacts generated to date and participants' satisfaction with the Course. Program representatives suggested that the Course has been very successful in achieving its objectives as evidenced by its impact in enhancing the language and professional communications skills of IEHPs, improving their understanding of the Canadian healthcare system and its work culture, and providing them with soft skills and tools that will help them succeed in the Canadian health care workplace. Current and past IEHPs identified similar objectives for participating in the Course including learning effective and professional communications in health care field, and improving their knowledge of medical terminology as

3.9

4.5

4.7

5.0

4.3

4.2

4.8

5.0

3.5

3.0

4.0

4.0

1 2 3 4 5

KPU Participants

MR Participants

MR Program Representatives

KPU Program Representatives

On a scale of 1 to 5, where 1 is no impact, 3 is somewhat of an impact, and 5 is major impact

Increasing participantlikelihood ofobtaining/retaining a job inthe health care sector

Heightening participantunderstanding of culturallyexpected behaviours and theprofessional culture of theCanadian health care system

Preparing participants toenter refresher/bridgingprograms, take a competencyexam, and/or apply for orobtain licensureN=10

N=18

N=18

N=14

N=16

N=15

N=3

N=4

N=3

N=2 N=6

N=2




well as health care system, culture and work environment. Other objectives were building confidence in speaking English, networking with other health care professionals, and preparing for the OSCE, MCAT and other exams. When asked to rate the success of the PC for IEHPs Course in achieving its objectives, on a scale of 1 to 5, where 1 is not at all successful, 3 is somewhat successful, and 5 is very successful, all Kwantlen representatives provided a rating of 5, and Mount Royal representatives provided an average rating of 4.5. The success ratings with respect to achieving their objectives averaged 3.9 amongst Mouth Royal and Kwantlen participants.

CHART 10: SUCCESS IN ACHIEVING INTENDED OBJECTIVES

Program participants were generally satisfied with the Course, and the impact it had in improving their ability to pursue their personal and professional goals. Participants were generally satisfied with the Course, and the impact it had in:

Building their confidence to work in professional settings; Improving communication with fellow health professionals and patients as well as

everyday life; Learning their own weaknesses and strengths; Helping them connect with other professionals in the field; Providing access to a support network; Supporting them in creating realistic goals and developing strategies in pursuing them;

and Gaining knowledge about the culture of the Canadian health care system and ethics of

care. Mount Royal focus group participants reported that the Course has had a significant impact on their clinical vocabulary as well as their ability to interact with different types of patients and handle difficult situations. They indicated that the PC for IEHPs Course is a very applicable and extensive program which covers all the areas needed for successful integration into the Canadian health care system. A few participants, however, were not very satisfied with the pace of the Course (it was too slow), and the diversity of guest speakers or contacts made (there were no doctors). Past Kwantlen participants generally identified that the Course contributed to their professional goals by helping them pass competency exams, enter other programs, and

3.9

3.9

5.0

4.5

1 2 3 4 5

Kwantlen

Mount Royal

Average Ratings

Success of the Course in achieving its objectives (as per Courserepresentatives)

Success of the participants in achieving their objectives for participating in theCourse (as per Course participants)

N=4

N=16

N=6

N=18




gain the communication and language tools (tone, word choice, posture) needed to become successful in the Canadian health care sector. Kwantlen program representatives received positive feedback from various groups and agencies which employed the participants. Employment agencies recognized the positive changes (i.e. improved communications skills, increased confidence etc.) in their clients. Program representatives from Mount Royal noted, in interviews as well as in the midterm and end-of-term surveys, that over 90% of participants expressed their satisfaction with the professional and cultural information and training received. However, Mount Royal program representatives indicated that the one area where the Program has not been as successful in achieving its objectives is in recruiting eligible applicants from all six of the targeted professions.

4. Aspects of the course considered to be most useful by program participants include the

role play exercises and the feedback received from the instructors. Most representatives and participants talked about the usefulness of tools, materials and information provided in helping IEHPs improve their English language skills in a medical context and understand the workplace culture. The most effective aspects of the Course, commonly cited by participants and representatives alike, include: The video-taped role play exercises. Most participants appreciated the opportunity to

deconstruct and reflect on their own communication skills and build their confidence in interacting with patients in the future. In particular, Mount Royal representatives highlighted the usefulness of learning to interact and communicate with patients through role-playing with stimulated patients. One respondent found the exercise very useful in learning about non-verbal communication in addition to learning how to improve verbal communication.

The feedback received from instructors on their homework, mock interviews with fellow students, and other exercises. Participants noted that instructor feedback helped them learn their strengths and weaknesses, provided encouragement and motivation, and helped them build confidence.

The opportunities to view video interviews between physicians and patients, which helped to demonstrate interviewing skills.

The articles and research material, such as information regarding patient-centered care, as well as the homework assignments were useful in maintaining participant interest and motivation.

The networks developed. The program gave participants an opportunity to network with others who are in similar situations and to build strong connections and support systems.

In addition, some program representatives noted that allowing participants to learn from each other and exposing them to a variety of attitudes, cultures and approaches towards patients care, and patient expectations, is a very important aspect of the Course. Mount Royal program representatives described the importance of providing realistic feedback to participants related to their short and long-term goals as well as their alternative plans. For example, a respondent mentioned that, if a doctor had not practiced medicine since 1995, then they should reconsider seeking licensure as they would not be permitted to work because they would have been out of practice for too long.




A few Mount Royal participants found the writing and reading assignments less useful, noting that the writing exercises were too grammar focused. One respondent commented that some readings were too lengthy and that the teacher lacked knowledge of medical terminology. In opposition to the majority of respondents, a couple of Mount Royal participants found the video-making exercises to be less useful. During the focus group with past Mount Royal participants, many indicated that more time should be allocated to practice as opposed to receiving feedback from their classmates. A few current participants from Kwantlen also said that the feedback received from their fellow classmates and homework assignments were somewhat less useful aspects of the Course. One participant noted that the class was not fast-paced enough for him while a past participant reported that some of the class lectures were less engaging. Lastly, one Kwantlen past participant reported that some of the in-class medical terminology was not relevant to his health profession.

5. Various factors contribute to the success of the Course in Kwantlen and Mount Royal.

Key factors which were identified as contributing to the success of the Course include:

The incorporation of communication practice through rehearsed and unrehearsed role-plays and simulated scenarios, which familiarize IEHPs with health professional-patient interactions in Canada. Through this performance-based methodology, participants are able to receive constructive feedback and self-reflect on their performances. Instructors noted that participants act very differently (i.e. they do not ―buy into it‖ to the same degree) when an instructor acts as a patient.

The involvement of health care clinical educators who fill the credibility gap that exists as a result of instructors lacking experience specific to the health care sector. Clinical educators are a valuable addition to the Course due to their ability to answer participant questions with respect to health care communication and current practices in a Canadian context, provide feedback to participants in role rehearsals, and add relevance to clinical practice setting for ESL instructors and participants.

The framework, conception and design of the Program, which is based on the Medical

Communication Assessment Project (M-CAP). The approach has proven to be very successful, as it is motivated by a particular view of the connection between language, culture, instruction and assessment that would distinguish the development of professional language proficiency for ELT programs from other approaches to language instruction.

Working together in collaboration as a team from the faculty standpoint. The English

instructors along with the nursing faculty bring the expertise and fill in the gaps for the participants.

Ensuring enough time is available for unstructured conversations and questions. Some

program representatives feel that having a student-led environment enables participants to work on the areas they feel they are lacking in.

The support received from informed program partners in shaping the Course contents

and ensuring that authentic and reliable practices are referenced. The Vancouver Coastal Health clinical educators, for example, have expertise in clinical practice and provided valuable input into the context of their profession. Program representatives




noted that working together in collaboration with the Mount Royal Language Institute has been invaluable.

Instructors’ willingness and openness to learning and taking on a new role as a

facilitator. In this program, the role of the instructor is more facilitative than instructive (as in traditional ESL courses). Utilizing this new performance-based method and acting as trainers rather than ESL teachers has been particularly effective.

The technical aspects of filming and use of technical equipment: videotaping was

essential to the success of the Course, as it allowed for the review of scenarios and analysis of participant language and communication skills.

D. LESSONS LEARNED AND OPPORTUNITIES FOR IMPROVEMENT The major findings of the evaluation regarding the lessons learned to date and the opportunities for improvement are as follows: 1. Best practices and lessons learned mainly focused on the design, delivery, and promotion

of the Course were identified.

Program representatives emphasized the importance of:

Collaborative planning and a team-approach to designing and deliverying of the Course, which includes instructors, clinical supervisors, coordinators and standardized patients as well as other experts in communication training and the Canadian health system;

Ensuring that IEHPs receive good language instruction as well as reliable and credible information about health care system;

The role played by clinical educators in filling the knowledge gap that exists given the limited experience of instructors in the health care workplace;

Strong technical/computer support; The performance-based approach; Tailoring existent successful frameworks and concepts, such as the M-CAP, to suit the

needs of the particular community/province rather than ―reinventing the wheel‖; Utilizing a variety of the effective promotional strategies in order to attract the interest and

participation of IEHPs in the Course; Clearly communicating Course objectives to participants in order to create realistic

expectations; and Tracking short-term and long-term Program results on an on-going basis to demonstrate

the impact of the Program.

2. Challenges and recommendations for improvement focused primarily on curriculum design, course delivery, and collaboration and information sharing.

Some of the challenges which were identified as facing the Courses included:

Ensuring access to diverse clinical educators (e.g. professional physicians, midwives,

occupational therapists) who can provide answers related to the various fields of IEHPs.

The high cost of Course delivery (e.g. costs associated with standardized patients, medical facilitators, ESL teachers, etc.). It was noted by one program representative that, with the delivery cost being relatively high, the Course ―could potentially be operated on a




cost-recovery basis but will never be revenue generating. Ongoing funding is thus essential to the successful delivery of the Course, as most participants could not afford to pay the full costs.

Attracting and recruiting applicants from each of the six targeted professions as well as, in the case of Mount Royal, filling all the available seats.

Ensuring regular Course attendance and keeping participant motivation at a high level through the end of the Course. Some participants become disheartened when the Course ends because they are aware of the barriers ahead and the competitive nature of the process to becoming a licensed health care professionals in Canada. According to one program representative, ―the reality of having to surmount other barriers is still there.‖

A summary of the recommendations received is provided in the following table.

TABLE 11: RECOMMENDATIONS PROVIDED BY PARTICIPANTS AND PROGRAM REPRESENTATIVES

Area Recommendation

Allocation of Time to

Particular Components

Expand the amount time spent with simulated patients (e.g. provide daily contact instead of having only 7 points of contact over the duration of the Course)

Introduce a more extensive writing practice component

Include more in-class training

Replace some writing exercises with practical, hands-on exercises with patients in order to better prepare participants for their license exams (e.g. include mock physical examinations with SPs)

Expand the medical vocabulary used in the classes to include more diseases and other medical terminology

Allocate more time to the cultural sensitivity component of the Course (e.g., introduce weekly cultural sensitivity exercises)

Include a Course component that extensively covers relevant abbreviations

Expand the Course content to cover a wider variety of topics, such as mental health and drug addiction (e.g. information on depression, major mental disorders and street drugs)

Target Groups

Revise the curriculum content and patient scenarios to be more relevant to all 6 targeted professions

Establish a class specifically for doctors, separate from a class for all other allied health professionals in order to better meet the unique needs of doctors/tailor the coursework to better meet the unique needs of doctors (e.g. place a greater emphasis on clinical medicine)

Online/ Technology

Include an online component

Encourage participants to get involved in e-learning and become computer-savvy




Area Recommendation

Program Length

Extend the Course length to encompass more training and writing components/allocate more of the existing class time to training and writing

Offer the Course over a longer period of time, breaking it into sections of time with breaks between each section (maybe 3 weeks of coursework at a time) to accommodate employment and family needs

Extend the Course by a month to ensure participants have enough time to absorb all of the new information and not be overwhelmed/more time is needed to do every aspect of the Course

Location

Increase access to the program by offering additional classes in various locations in and around Vancouver

Deliver the Course in a clinic or hospital in order to devote more time to the clinical aspects of health (e.g. visit health care facilities, include physical examination of patients, or spend up to 6 weeks of the course in a hospital setting)

Stage regular classes in the lab where the video recording exercises have been held

Instructors Provide instructors with opportunities to become more knowledgeable of the

healthcare system

Course Delivery

Do not involve feedback from other participants when evaluating the role play performances

Enable more opportunities for teachers to offer assistance to students

Collaboration & Information

Sharing

Collaborate and communicate with various medical networks and different communities to expand participant networks and to allow for more information sharing

Encourage continued collaboration between Course providers, recognizing the benefits to both parties which results from having the Mount Royal Program Coordinator speak about Mount Royal experiences and Kwantlen representatives elaborate on core principles (i.e. clinical educator and relevancy of the content) through dialogue with Mount Royal representatives

Establish more and strengthen existing relationships with the medical community and other potential sources of referrals

Promotion

In order to increase Course enrolment and target a wider audience, Mount Royal should expand its networks and advertise externally through various means, such community churches, the Calgary Immigration Society, cultural groups, associations (e.g. College & Association of Registered Nurses of Alberta - CARNA), and cultural newspapers for immigrants

Other

Make the PC for IEHPs Course a pre-requisite to licensure

Include simulated patients from diverse cultural backgrounds (e.g. Indian, Chinese, Japanese etc.) to better understand how to interact with patients from different ethnic groups

Present the curriculum in a professional book format and include all the manuals needed for the entire Course in the one book



MAJOR CONCLUSIONS


IV. MAJOR CONCLUSIONS The major conclusions arising from the evaluation include: 1. There is a strong need for the PC for IEHPs Course.

Program representatives and participants from both institutes noted that there is a strong need to help IEHPs overcome some of the barriers they face in entering health profession field such as communication barriers, lack of understanding of patient care in Canada, limited medical vocabulary, and lack of familiarity with culturally appropriate behaviors when dealing with patients. Literature review suggests that there is on-going shortage of health professionals in British Columbia and Alberta as well as other jurisdictions. Recruitment and support of IEHPs in pursuing their careers in Canada is both a policy and a practice of individual health authorities as well as the provincial and federal governments. Although other education programs and resources have been designed to assist foreign trained health professionals further develop their language skills and adapt to the local work environment, PC for IEHPs is unique in its approach (strong focus on the performance based approach), and diversity of professions it targets. Past and present participants of the Course suggested that the Course' unique structure, fills a key gap which exists between a general ESL courses and a professional development programs, and therefore helps them improve their professional communication, and integrate into the workplace.

2. The curriculum is considered to be well adjusted to meet the needs of IEHPs in BC and

Alberta. The Course’s flexible delivery structure and its strong focus on performance-based instruction were emphasized as important aspects in meeting the needs of IEHPs from diverse professional backgrounds.

Apart from some delays in the implementation at Mount Royal, to allow for design adjustments made to the curriculum, the Course was largely implemented as planned in both regions. Most program representatives and participants considered the curriculum to be well-designed to meet the language and professional needs of the participants. They further noted that instructors are effective in teaching pronunciation and vocabulary and classes are well-structured and include vital components such as listening and reading exercises, vocabulary expansion, and role-playing. Mount Royal participants particularly valued class delivery in the laboratory settings. Sufficient support has been provided to instructors to deliver the course including curriculum and teaching material (e.g. hand outs), technical equipment, space, clinical instructors and guest speakers. Achieving cost savings without negatively impacting the quality and effectiveness of the Course is a particular area of focus and importance to representatives at both institutes. Effective program promotion to fill available seats will require more effort in the future, particularly at Mount Royal. Representatives from both institutes emphasized the importance of providing participants with access to both qualified language instructors to teach the course as well as health professionals who bring experience in a clinical setting. Such a program structure, however, is costly. The high costs of the program, combined with the limited financial resources of many IEHPs, may mean that direct federal or provincial government funding will be needed to sustain these programs on an on-going basis.

3. Although there are some differences in the curriculum and delivery methods between the two programs, there is no data to suggest that one is more or less effective than the other.


MAJOR CONCLUSIONS


There are many more similarities than differences between the two programs. Both programs are continuing to evolve as experience in gained. One of the strengths of involving two institutions in delivery is that they have been willing and able to share information, best practices, lessons learned and resources with each other. Although a common recommendation from participants from both institutions was to extend the length of the course, it does not appear that the decision to shorten the course at Mount Royal has had a negative impact on either by three weeks had on achievement of the intended objectives or student outcomes.

4. Judging by the feedback received from program representatives and participants, the Course has been successful in achieving its objectives and intended impacts in the short-term.

Participants from both Mount Royal and Kwantlen suggested that the course has been very successful in achieving its objectives in terms of improving their professional communication skills, understanding of work culture and the health care system in Canada, building their confidence to pursue the career in health care, and helping them prepare for tests or courses they need to take.

The course played an important role in preparing past participants from Mount Royal to take competency exams and apply for licensure. By encouraging them, preparing them to take the necessary tests or courses needed to obtain licensure, and improving their skills and understanding of the process, health system and work culture, the course serves to improve the employability of these IEHPs in the healthcare sector.

5. Factors that contribute to program success include involvement of the healthcare

educators, commitment of instructors to meet the individual needs of participants, and the support provided by program partners.

Various factors contributed to the effectiveness of the course, particularly in the areas of improving student professional communication skills and enhancing their ability to continue their practice in the Canadian healthcare context. Its unique design, which includes involvement of health care clinical educators in addition to language instruction, makes this Course particularly effective and relevant to IEHPs. Other essential components of the Course include role-plays and simulated medical scenarios, the opportunities to practice communication with patients and caregivers, and the opportunities to network and offer solutions related to the patient safety issues.

The facilitative approach to teaching and the strong commitment of instructors to meet the individual needs of participants is important for effective delivery of the Course. Financial, technical and other supports from program partners are vital in delivering all aspects of the Course that make it unique and effective in helping IEHPs.

Other key success factors and best practices which were identified include employing a variety of the effective promotional strategies to attract the interest and participation of IEHPs in the course, clearly communicating course objectives to participants to create realistic expectations, the performance-based approach, having access to strong technical/computer support, regularly updating the curriculum, and continuing communication and collaboration between the two course providers.

6. Various opportunities for improvement could be considered to better meet course


MAJOR CONCLUSIONS


objectives and increase the number of students taking the course. The opportunities focus primarily on increasing recruitment and promotion strategies and ensuring that the curriculum remains relevant for all IEHPs.

The major recommendations arising from the review are as follows:

Expand the recruitment and promotion strategies. Recruitment and promotion

strategies should include wide range of partners and institutions that work with the similar target groups (e.g. hospitals, clinics, settlement agencies, municipal and provincial governments).

Increase the number of guest speakers and cover a wider variety of topics to make

the curriculum more relevant for a wide variety of IEHPs (e.g. invite guest speakers from mental health and drug addiction).

Clinical instructor should be available to provide feedback for role rehearsals.

Expertise, advice and feedback from clinical advisors were very important to participants in the Course.

Ensure that individualized learning approach is utilized throughout the term (e.g.

working closely with participants to develop goals and learning strategies for each participant).

Make the results of the evaluation available to other institutions which may be

interested in staging a similar program in other regions of the province.

Assist institutions delivering the Course to identify and secure potential sources of funding, such as HRSDC and CIC. The program is expensive to deliver and will likely need some form of on-going government support in order to remain affordable to target participants.

Other recommendations commonly provided by participants include adding a clinical component to the Course (e.g. visiting health care facilities and spending a portion of the classes in a hospital setting), and offering the Course over a longer period of time to make it more accommodating to individuals who have work and family obligations.

Appendices

Appendices


APPENDICES

Evaluation of the PC for IEHPs Course Page A - 1

APPENDIX I: QUESTIONNAIRE FOR PC FOR PARTICIPANTS

Good morning/afternoon. My name is ____________ and I am calling from Ference Weicker and Company, management consulting firm. Our firm has been hired by the Government of British Columbia, (more specifically, the Ministry of Regional Economic and Skills Development) to conduct an evaluation of the Professional Communication for Internationally Educated Health Professionals (IEHP) Course. As part of this process we are conducting interviews with individuals who are involved in the program. We would like to talk to you for about 20 to 30 minutes about the program. Do you have some time right now to answer few questions? If not, can we set up another time?

RESPONDENT INFORMATION

Name:

Phone Number:

Organization:

Community:

A. INVOLVEMENT IN AND NEED FOR THE PROGRAM

1. How did you first hear about the PC for IEHPs?

Referred by a course participant Referred by a friend or family member Referred by another organization Read a brochure or other print literature Found it on internet Saw a presentation on the program Other

2. When did you first start participating in the Course?

Month and year

3. On a scale of 1 to 5, where 1 is not at all significant, 3 is somewhat significant, and 5 is very significant, how significant do you think are the barriers facing internationally educated health professionals?

Not significant at all Somewhat Very significant

1 2 3 4 5 N/A

3a. (if 2 or more) What do you see as the major barriers? _____

_____ _____


APPENDICES


_____ _____

_________________________________________

4. On a scale of 1 to 5, where 1 is no need at all, 3 is somewhat of a need, and 5 is major

need, how much of a need do you think there is for this type of course?

Not Need at All Somewhat Major Need

1 2 3 4 5 N/A

4a. Why is that? _____

_____

_____

B. IMPACT OF THE COURSE 1. What were your objectives for participating in the PC for IEHPs? _____

_____

_____

_____

2. On a scale of 1 to 5, where 1 is not at all successful, 3 is somewhat successful and 5 is

very successful, how successful were you in achieving your objectives?

Not at all Successful Somewhat Very Successful

1 2 3 4 5 N/A


_____

_____

3. Which aspects of the Course did you find most useful? _____

_____

_____

_____

4. Which aspects of the Course did you find less useful? _____

_____


APPENDICES


_____

_____ 5. Participating in the PC for IEHPs can help participants in a variety of ways. On a scale of

1 to 5, where 1 is no impact at all, 3 is somewhat of an impact, and 5 is a major impact, how much of an impact do you believe that participating in the PC for IEHPs has had in terms of:

How much of an impact do you believe the PC for IEHPs has had in terms of:

Rating of Impact No

Impact Somewhat Major Impact N/A

1 2 3 4 5 N/A

a Improving your English language competency specific to the health care sector?

1 2 3 4 5 N/A

(if 3 or more) In what way? (if 2 or less) Why is that?

b

Heightening your understanding of culturally expected behaviours and the professional culture of the Canadian health care system?

1 2 3 4 5 N/A


c Increasing your likelihood of obtaining/retaining a job in the health care sector?

1 2 3 4 5 N/A


What is our current work status?

Employed full-time in my professional health field Employed part-time in my professional health field Employed full-time, but not in my professional health field Employed part-time, but not in my professional health field Employed casually Unemployed and seeking employment Unemployed and not seeking employment Full-time student Part-time student Other


APPENDICES



Rating of Impact No


1 2 3 4 5 N/A

d Improving your ability to meet your professional and personal goals?

1 2 3 4 5 N/A


6. Since participating in the program, have you:

Since participating in the course have you: Yes/No

Yes No

a Taken any competency exams Yes No

(if yes) On a scale of 1 to 5, where 1 is not at all important, 3 is somewhat important, and 5 is very important, how important was the course in preparing you for this?

Not at all Important Somewhat Very Important

1 2 3 4 5 N/A

Why is that?

b Applied for or obtained licensure Yes No



1 2 3 4 5 N/A

Why is that?

c Entered a refresher/bridging program Yes No


APPENDICES


Since participating in the course have you: Yes/No

Yes No

(if yes) Which refresher/bridging program(s)?



1 2 3 4 5 N/A

Why is that?

6a. What other actions have you taken since completing the Course which are relevant to

working as a health care professional? _____

_____ _____

_____ _____

_____ _____

7. What other impacts (positive and negative) has participating in the PC for IEHPs had on

you? _____

_____

_____

_____

8. The following are some statements about the PC for IEHPs. Please specify whether you strongly disagree, somewhat disagree, neither agree nor disagree, somewhat agree, or strongly agree that:

Please specify whether you strongly disagree, somewhat disagree, neither agree nor disagree, somewhat agree, or strongly agree that:

Agreement Scale

Strongly Disagree

Somewhat Disagree

Neither Agree Nor Disagree

Somewhat Agree

Strongly Agree

n/a

a The curriculum was well designed to meet my needs

Strongly Disagree

Somewhat Disagree

Neither Somewhat

Agree Strongly Agree

n/a


APPENDICES



Agreement Scale

Strongly Disagree

Somewhat Disagree


Somewhat Agree

Strongly Agree

n/a

(if disagree or strongly disagree) Why is that? Do you have any recommendations to improve it?

b Instructors are well-qualified to deliver the course

Strongly Disagree

Somewhat Disagree

Neither Somewhat


n/a


c The instructor-to-student ratio is appropriate Strongly Disagree

Somewhat Disagree

Neither Somewhat


n/a


d The course was delivered in the appropriate location

Strongly Disagree

Somewhat Disagree

Neither Somewhat


n/a

(if disagree or strongly disagree) Why is that? Where else could the course be delivered?

9. How could the Course be improved or further developed? _____

____ _____ _____

_____ _____

_____ _____

C. BACKGROUND OF THE RESPONDENT

1. When did you arrive in Canada? Month and Year

2. What country did you emigrate from?


APPENDICES


____________________

3. What specific health discipline were you internationally educated in?

Nursing Medicine Midwifery Pharmacy Physical Therapy Occupational Therapy Other

4. Do you have any final comments or recommendations? _____

_____ _____

_____ _____

_____ _____

THANK YOU FOR YOU PARTICIPATION!


APPENDICES


APPENDIX II: QUESTIONNAIRE FOR REPRESENTATIVES OF JTI, KWANTLEN POLYTECHNIC UNIVERSITY, VANCOUVER COASTAL HEALTH

AND MOUNT ROYAL UNIVERSITY Good morning/afternoon. My name is ____________ and I am calling from Ference Weicker and Company, management consulting firm. Our firm has been hired by the Government of British Columbia, (more specifically, the Ministry of Regional Economic and Skills Development) to conduct an evaluation of the Professional Communication for Internationally Educated Health Professionals (IEHP) Course. As part of this process we are conducting interviews with individuals who are involved in the program. We would like to talk to you for about 20 to 30 minutes about the program. Do you have some time right now to answer few questions? If not, can we set up another time?

CONTACT INFORMATION

Respondent

Position

Organization

Phone

A. INVOLVEMENT IN THE PROGRAM

1. What has been your role in the development and delivery of the PC for IEHPs? _____

_____ _____

_____ _____

_____ _____

2. How long have you been involved with the PC for IEHPs?

# of Years or Months

3. Approximately how many hours per month do you spend on activities related to the PC for IEHPs?

# of hours per month

3a. On what activities do you spend the majority of this time? _____ _____

_____

_____

_____

4. Has the course been implemented largely as planned?


APPENDICES


Yes No Don’t Know

IF YES, GO TO QUESTION B1

4a. (if no) What major changes were made? _____ _____ _____

_____ _____

_____ _____

_______________________

4b. What major factors contributed to changes in how the course was delivered? _____

_____ _____ _____ _____

_____ _____ _____

_____ _____ _____

4c. Did these changes have an impact on the effectiveness of the course?

Yes No Don’t Know

4d. (if yes) In what way? _____ _____ _____ _____

_____ _____ _____ _____

_____ _____ _____

_____ _____ _____

B. IMPACTS OF THE COURSE 1. From your perspective, what are the objectives of the PC for IEHPs? What was it

designed to accomplish? ______________________________________________________ _____ _____

_____ _____

____________________________________________________

2. Overall, on a scale of 1 to 5, where 1 is not at all successful, 3 is somewhat successful and 5 is very successful, how successful do you believe the PC for IEHPs has been to date in achieving its objectives?

Not at All Successful Somewhat Very Successful

1 2 3 4 5 N/A


APPENDICES



_____

_____

3. In what areas has the Course been particularly effective? _____ _____

_____ _____ _____

_____ _____ _____

_____ _________________

4. What would you say are some of the major factors that have contributed to the success

of the course? _____

_____

_____

_____

5. In what areas has the Course been less effective? _____ _____ _____

_____ _____ _____ _____

_____ _____ _____ _____

_____ _______________________

6. What, if any, factors have constrained the success of the Course to date? _____

_____ _____

_____ _____

_____ _____

7. Participating in the PC for IEHPs can help participants in a variety of ways. On a scale of

1 to 5, where 1 is no impact at all, 3 is somewhat of an impact, and 5 is a major impact, how much of an impact do you believe that participating in the PC for IEHPs has had in terms of:


Rating of Impact No


1 2 3 4 5 N/A


APPENDICES



Rating of Impact No


1 2 3 4 5 N/A

a Improving participant English language competency specific to the health care sector?

1 2 3 4 5 N/A


b

Heightening participant understanding of culturally expected behaviours and the professional culture of the Canadian health care system?

1 2 3 4 5 N/A


c Improving the results of participants in competency exams?

1 2 3 4 5 N/A


d Helping participants to obtain licensure in their professional field?

1 2 3 4 5 N/A


e Enabling participants to access refresher/bridging programs?

1 2 3 4 5 N/A


f Increasing participant likelihood of obtaining/retaining a job in the health care sector?

1 2 3 4 5 N/A



APPENDICES



Rating of Impact No


1 2 3 4 5 N/A

g Improving the ability of participants to meet their professional and personal goals?

1 2 3 4 5 N/A


8. What other impacts (positive and negative) have been generated by the PC for IEHPs?

_____ _____

_____ ___________

_____ _____ _____

_____ _____ _____

C. DESIGN AND DELIVERY

1. On a scale of 1 to 5, where 1 is not need at all, 3 is somewhat of a need, and 5 is major need, how much of a need do you believe there is for the PC for IEHPs?

Not Need at All Somewhat Major Need

1 2 3 4 5 N/A


_____

_____

2. The following are some statements about the PC for IEHPs. Please specify whether you

strongly disagree, somewhat disagree, neither agree nor disagree, somewhat agree, or strongly agree that:


Agreement Scale

Strongly Disagree

Somewhat Disagree


Somewhat Agree

Strongly Agree

n/a

a

The PC for IEHPs is well-designed to meet the language and professional needs of newcomers it serves

Strongly Disagree

Somewhat Disagree

Neither Somewhat


n/a


APPENDICES



Agreement Scale

Strongly Disagree

Somewhat Disagree


Somewhat Agree

Strongly Agree

n/a


b The structure of the IEHP is flexible enough to be able to respond to individual needs

Strongly Disagree

Somewhat Disagree

Neither Somewhat


n/a


c The curriculum is well designed and appropriate for participants

Strongly Disagree

Somewhat Disagree

Neither Somewhat


n/a


d The efforts to promote the PC for IEHPs have been adequate and effective

Strongly Disagree

Somewhat Disagree

Neither Somewhat


n/a

How is the course promoted?


e

The course has been successful in attracting the type of students who would benefit from these types of services

Strongly Disagree

Somewhat Disagree

Neither Somewhat


n/a


f Instructors have the qualifications necessary to deliver the course

Strongly Disagree

Somewhat Disagree

Neither Somewhat


n/a


APPENDICES



Agreement Scale

Strongly Disagree

Somewhat Disagree


Somewhat Agree

Strongly Agree

n/a

(if disagree or strongly disagree) Why is that? Do you have any recommendations to improve it? Should instructors be trained in this model of delivery?

g The instructor-to-student ratio is appropriate Strongly Disagree

Somewhat Disagree

Neither Somewhat


n/a


h The course is delivered in the appropriate location

Strongly Disagree

Somewhat Disagree

Neither Somewhat


n/a

(if disagree or strongly disagree) Why is that? Where else could the course be delivered?

i The classroom, space and technical requirements of the course are being met

Strongly Disagree

Somewhat Disagree

Neither Somewhat


n/a


j The assessment processes are well designed and appropriate for participants

Strongly Disagree

Somewhat Disagree

Neither Somewhat


n/a


k The monitoring and reporting mechanisms for the PC for IEHPs are appropriate

Strongly Disagree

Somewhat Disagree

Neither Somewhat


n/a


APPENDICES



Agreement Scale

Strongly Disagree

Somewhat Disagree


Somewhat Agree

Strongly Agree

n/a

What mechanisms and systems do you have in place? How do you track the data?


l The Program is a cost-effective way of delivering these types of services

Strongly Disagree

Somewhat Disagree

Neither Somewhat


n/a

What are the main factors affects the cost of course delivery?

(if disagree or strongly disagree) Why is that? Are there opportunities to improve the cost-effectiveness?

3. Apart from what you may have mentioned so far, how could the course be improved or

further developed? _____ _____ _____ _____

_____ _____ _____ _____

_____ _____ _____ _____

__________________________________________________________

4. What lessons have been learned thus far that may have implications for delivery of the

course in the future? What best practices have been identified that should be

considered going forward? _____ _____ _____ _____

_____ _____ _____ _____ _____

_____ _____ _____ _____ _____

_____ ____________________________________________________


APPENDICES


5. Do you have any final comments or recommendations? _____ _____ _____

_____ _____ _____ _____ _____

_____ _____ _____ _____ _____

_____ _____ _____________________________

THANK YOU FOR YOUR PARTICIPATION!

APPENDIX III: FOCUS GROUP GUIDE - STAKEHOLDERS


APPENDICES


A focus group session will be held in March involving stakeholders. The focus group is designed to obtain input on need for the program; impacts on the development of student skills; impacts on the integration of participants into the professions; perceived strengths and weaknesses of the course; and opportunities for improvement. The focus group will be divided into the following major segments: Introductions (stakeholders’ names, positions, organizations, their involvement/roles with the PC for IEHPs Course) Introduction of Ference Weicker & Company

Purpose of the Evaluation

Methodology

Purpose of the Focus Group

Discussion Facilitated by Ference Weicker and Company Need for the Program

How much of a need is there for the PC for IEHPs? Why is that?

Is the Program designed appropriately to respond to these needs? Does it provide the right type of assistance?

Are you aware of any similar programs in your community?

Does the Program complement or duplicate other programs and resources in the community? In what way?

Achievement of Intended Impacts

Overall, what do you see as the primary objectives of the Program?

How successful do you believe the PC for IEHPs has been to date in achieving its objectives? In what way?

How successful has the Program been in achieving its intended impacts? o Improving participants’ English language competency specific to the health care sector o Heightening participants’ understanding of culturally expected behaviours and the professional

culture of the Canadian health care system o Improving the results of participants in competency exams o Helping participants to obtain licensure in their professional field o Enabling participants to access refresher/bridging programs o Increasing participant likelihood of obtaining/retaining a job in the health care sector o Improving the ability of participants to meet their professional and personal goals

What factors have contributed to the success of the Program

What factors, if any, have constrained the success of the Program to date Recommendations/Opportunities for Improvement

How could the course be improved or further developed? (suggestions for improvement in the curriculum as well as delivery)

What lessons have been learned thus far that may have implications for delivery of the course in the future? What best practices have been identified that should be considered going forward?

APPENDIX IV: FOCUS GROUP GUIDE - PARTICIPANTS


APPENDICES


A focus group session will be held in March involving past or current participants of the PC for IEHPs Course. The focus group is designed to obtain input on need for the program; impacts on the development of student skills (e.g., language competency and understanding of the cultural and communication needs within the Canadian health professions); impact on the integration of participants into the professions; the level of participant satisfaction including perceived strengths and weaknesses of the course; and opportunities for improvement. The focus group will be divided into the following major segments: Introductions (participants’ names, positions, how and when they learned about the PC for IEHPs Course) Introduction of Ference Weicker & Company

Purpose of the Evaluation

Methodology

Purpose of the Focus Group

Discussion Facilitated by Ference Weicker and Company Need for the Program

How much of a need is there for the PC for IEHPs Course? Why is that?

Is the Program designed appropriately to respond to these needs? Does it provide the right type of assistance?

Are you aware of any similar programs in your community? Achievement of Intended Impacts

Overall, what were your objectives for participating in the Program?

How effective was the Program in achieving these objectives?

How has participating in the Program helped you so far?

How successful was the Program in: o Improving your English language competency specific to the health care sector? o Heightening your understanding of culturally expected behaviours and the professional

culture of the Canadian health care system? o Increasing your likelihood of obtaining/retaining a job in the health care sector? o Improving your ability to meet your professional and personal goals?

What factors have contributed to the usefulness of the Program for you?

What factors, if any, have constrained the usefulness of the Program for you? Recommendations/Opportunities for Improvement

How could the course be improved or further developed? (suggestions for improvement in the curriculum as well as delivery)

Would you recommend this course to other IEHPs?

APPENDIX V: FOCUS GROUP WAIVER FOR PARTICIPANTS

I. STUDY PURPOSE


APPENDICES


The Ministry of Regional Economic and Skills Development (RESD) has commissioned an evaluation of the IEHP, which is intended to: Determine if the curriculum and delivery of the PC for IEHPs achieved its intended objectives and student

outcomes in British Columbia and Alberta; Make recommendations for improvements in the curriculum as well as delivery to meet the course objectives

and increase the number of students taking the course in British Columbia; and Compare the curriculum, delivery methods, and outcomes between British Columbia and Alberta to

determine the pros and cons of each version, including: a. What changes were made under the license to AB? b. Are the changes that were made in AB ones which BC wants to incorporate into the original version (or

maintain as an alternate version)? c. What effect has shortening the course by three weeks had on student outcomes?

II. STUDY PROCEDURES AND CONFIDENTIALITY

You are being invited to participate in an evaluation of the Professional Communication for Internationally Educated Health Professionals (IEHPs) that uses a focus group to obtain your perceptions on the need, appropriateness, impacts and success of the program thus far. The focus group will last approximately one hour and will be led by Don Ference, Senior Partner and President of Ference Weicker and Company Ltd. Refreshments will be provided. Your assistance is voluntary and all information provided will be protected under the provisions of the Federal Privacy Act. The discussion in the focus group will be tape recorded and transcribed following the session, but you will not be identified individually on the transcripts. Your name will not be on the transcripts of the focus group. In addition, your responses will not be seen by course faculty or by faculty with any direct decision making regarding course progression. Recordings will be kept in a secure and locked area with access limited to designated researchers. Recordings will be destroyed after data analysis or completion of the study.

III. BENEFITS OF PARTICIPATING Your input will be used to improve the PC for IEHPs in terms of its design and delivery structure. Your voluntary participation in this study may also assist other academic institutions in the design and implementation of similar programs and courses for health professional like yourself.

IV. OPTION TO WITHDRAW You may withdraw from this study at any time without penalty. If you leave the study, your relationships with Mount Royal University will not be negatively affected. Your participation or non-participation will not affect your academic standing.

V. CONSENT You voluntarily agree to participate in this study.

Participant Name (please print) Signature Date If you have any questions regarding this evaluation, please call Ted Weicker, Senior Partner of Ference Weicker & Company at 604-688-2424

ext. 305.

APPENDIX VI: PROFILE OF OTHER LANGUAGE RELATED PROGRAMS TARGETED AT FOREIGN TRAINED PROFESSIONALS


APPENDICES


A. EXAMPLES OF CANADIAN PROGRAMS

Type of Program Teaching English to Foreign Trained Health Professionals

Region British Columbia

Name of Project Vancouver Medical English Institute

Target group Non-native English speaking medical professionals with intermediate level English skills

Focus of program

Provide immersion courses to teach medical English

Teach culturally appropriate communication skills for practicing medical careers in an

English speaking environment

Location Vancouver campus classroom or abroad classroom campuses

Description

Offers one, two and three month certificate courses with 2 options: Core Medical English

Course or Practicing Medical English Course

Core Medical English Course is for duration of four months. Course content

include: medical terminology, role playing, emergency vocabulary, interview

techniques with patients, medical procedures and medical communication with

other professionals

Practicing Medical English Course is for duration of four months. Course content:

English conversation, pronunciation, speaking, reading and also observing

Canadian medical professionals

All classes are limited to a maximum of six students per class

Programs delivered abroad are one-month intensives with Canadian trained instructors.

Abroad programs require international institution to request the course be delivered to

their students


Region: Across Canada

Program Name Orientation to Canadian Health Care System, Culture and Context

Target group

Internationally educated health professionals either newly arrived and living in Canada or

living abroad and planning to come to Canada and want to work in the Canadian health

care sector

Focus of program

The program is designed to assist internationally educated health professionals to

become licensed to work in the Canada

The program provides learners with:

A deepened understanding of the Canadian health care system; Description of what Canadian patients expect from their health care providers; and An understanding of how to communicate with patients and caregivers

Location Delivered online

Description

A 30-hour course offered through University of Toronto and other affiliate universities

delivered over 10 weeks and includes interactive learning exercises including:

Provincial delivery of care;

Patient safety;

Canadian health care professionalism;

Reflective practice;

Ethics and liability;

Issues in cultural competence and

Case integration

Successful participants receive a Certificate of Completion upon finishing the course

Type of Program Training Foreign Trained Pharmacists to work in Canada

Region Manitoba

Program Name Prescription for Learning: Communication Skills for the Practice of Pharmacy


APPENDICES


Type of Program Training Foreign Trained Pharmacists to work in Canada

Target group

Internationally educated pharmacists who have met Manitoba Pharmaceutical

Association requirements to begin an internship or for employees who have been

requested by an employer take the course

Focus of program

To teach integration communication techniques and how pharmacists can work in a

Canadian pharmacy setting

To provide professional development tools for communicating with clients and for

becoming certified to work in Canada as a pharmacist

Location Classroom setting

Description

Program length is 50 hours over 7 days with exercises including: role play,

discussion, guest speakers and case studies to study communication

The goal of the program is to learn the culture of Canadian health care system,

communication, problem solving and written communications

A travelling mentor monitors participants at their work sites when working at

pharmacies and are evaluated and provided feedback to instructors of the course

Program is delivered by two, part-time instructors

Successful participants are provided a Certificate of Completion upon finishing the

program

The course is no longer offered


Region Alberta

Name of program Medical Communication Assessment Project (MCAP)

Target group Immigrant medical graduates who are Canadian citizens or permanent residents

and have passed the MCCEE and MCCQE1 exams

Focus of program

To increase students’ medical communication skills for successful integration into

the Canadian healthcare system using a patient-centred model of care

Focus on language proficiency, communication skills and cultural understanding for

successful entry into the health care career

Location University of Calgary and the University of Alberta classrooms for 8 weeks

Four weeks in a clinical setting where participants are supervised

Description

The program is performance-based, teaching communication skills for immigrant

medical graduates to overcome cultural, social and linguistic barriers to make it

through:

Their next round of exams (e.g. Objective Structured Clinical Examination or

Medical Council of Canada Qualifying Examination)

Residency programs

Clinical assistant positions; or

Other similar positions

The program uses language instructors, standardized clinical case scenarios,

physician feedback and standardized patients (professional actors) to create

authentic situations involving communication, relevant to the practice of medicine

Includes a full-time 4 week clinical placement component and an 8 week

instructional component.

The in-class instructional component is designed to provide background information

on the professional culture of medical practice in Canada; to familiarize students

with doctor-patient interactions in Canada through case studies; to provide

appropriate language and communication mentoring using the Calgary-Cambridge

Communication Guides as a reference tool; and, lastly, involves video-taped

recording and a performance reflection log as a means of critically evaluating

oneself.

The clinical component is intended for participants to observe the medical context,


APPENDICES



interact with patients under direct supervision of the physician, become familiar with

charts and prescriptions, and to develop an understanding of Canadian cultural

scenarios commonly encountered in practice


Region Ontario

Program Name Centre for the Evaluation of Health Professionals Educated Abroad (CEHPEA)

Target group

Internationally educated health professionals who want to learn how to obtain a

career in the health care system either prior to commencing a residency program or

prior to beginning a specialty residency training program

Focus of program

Provides evaluation and orientation services: 1) provides assessment for PGY1

level assessment and Specialist Stream assessments (depending on the specialties

offered by year) 2) Pre-Residency Programs or Orientation to Training and Practice

in Canada

Orientation services are for candidates who are accepted into a specialty residency

training program and the Pre-Residency Program offered as a mandatory program

for all international medical graduates to complete before entering a residency in an

Ontario university hospital

Location

Pre-Residency Programs involve six weeks in classroom setting at CEHPEA centre

in downtown Toronto and then 10 weeks at the university in a classroom setting

Orientation to Training and Practice in Canada includes both classroom and online

learning

Description

The Pre-Residency Program involves class work learning where the participant

learns communication skills and knowledge of the Canadian medical culture

For participants of the Orientation to Training and Practice in Canada, they complete

classroom and online exercises with a focus on patient-centred care. They also

familiarize themselves with documentation they are required to use in their

Canadian healthcare sector and become more familiar with the culture of the

Canadian medical system specific to their specialty.

The Pre-Residency Program also involves class work learning where the participant

learns communication skills and knowledge of the Canadian medical culture

2. EXAMPLES OF PROGRAMS IN OTHER COUNTRIES


Region Florida

Name of Program Foreign Physician Alternative Certification Program (FOPAC)

Target group The program is targeted at trained health professionals who are living in the US and

have only practiced medicine in another country

Focus of program

Programming is intended to either assist internationally trained health professional

to obtain licensure through medical English examination practice and guidance or

for their students to retrain in other in-demand health care jobs other than the field

they are internationally trained for

The program provides assistance to internationally trained health professionals in

order for them to gain employment in the health sector and urge those who hold a

job that requires little to no education to recertify themselves

Location Miami Dade College classrooms

Description

Provides orientation, assistance and training for foreign trained health care

professionals living in the US

Provides two types of programming: 1) assist foreign educated physicians to have

the opportunity to gain licensure and work as a practicing medical doctor and 2)


APPENDICES



retrain foreign health care professionals to obtain degrees in other in-demand areas

Retraining may include health care areas such as: nursing, medical lab technology,

respiratory care, sonography or teaching

The curriculum is designed to include content that is on required exams such as

immunology and microbiology and is taught by a certified clinical practitioners who

specialize in the topic(s)

The course is offered through Miami Dade College for 30 hours a week

Type of Program Teaching English for Foreign Trained Physicians

Region California

Name of Program UCLA International Medical Graduates Program (IMG)

Target group

International medical graduate from a Spanish speaking country in pre-residency

who have received a score of at least 500 in the National Board of Medical

Examination (NBME)

Targets Spanish speaking immigrant health professionals whose goal is to become

a licensed physician in underserved communities

Focus of program

The program is intended to increase the number of Hispanic doctors in the USA and

is designed for Spanish speaking medical graduates who want to practice Family

Medicine in California to serve Spanish speaking populations

The program works to provide healthcare to immigrants and low-income Spanish

speaking patients who face financial and language barriers when seeking health

care.

Location

Step 1 in UCLA classroom, step 2 in UCLA Family Health Centre including some

observation of clinical work by physicians

Simultaneously during Steps 1, 2 and 3 students attend ESL class work at LA City

College

Step 3 includes 3 months Observership in a clinical setting

18 to 36 months in an underserved community clinic setting

Description

Prepares students to pass USMLE step 1 involving Basic Science and English for

Health professionals class work, learning to pass USMLE step 2 CK and CS

learning clinical science and step 3 is an Observership once passed minimum

scores for exams in steps 1 and 2

Oberservship is 60 hours per week and involves attending didactic sessions

Includes weekly ESL Language Learning classes

Depending on experience and skills, the program can be shortened and participants

may bypass the first 2 classroom programs and begin the Observership

The IMG Program prepares participants to be licensed California family physicians.

They are provided assistance in exam preparation and residency placement and

then commit to train in Family Medicine and practice in an underserved area, rural

or urban, for 18 to 36 months after completing their residency in exchange.

In total, the program is a 3 year training program, 50 hours per week full-time


Region London

Program Name The Kingsmore International Medical English Course

Target group Health care professionals with at least intermediate English skills who want to work

in the UK health sector

Focus of program

To develop participants’ ability to use and understand English in a range of medical

contexts

Participants are taught medical English language skills

Location Clinical setting practicing working with patients in Bournemouth


APPENDICES



Classroom setting for studying and learning medical English

Description

Includes teaching medical English and career development services to support

doctors, nurses and medical professionals who seek to certify themselves in a UK

health profession

Includes a 25 week coursework with 3 hours of general English teaching per day

and social and cultural programs. Classes include a maximum of 8 students

Designed to teach participants how to communicate effectively with patients and

professional colleagues, learn about UK health care system, network with

prospective employers, acquire medical application guidance and discuss

treatments

Type of Program Assisting Non-working Foreign Trained Immigrant Physicians

Region: Across Portugal

Program Name Professional Integration of Immigrant Doctors Project

Target group Immigrant doctors who were not currently working in the medical profession

Focus of program

To bridge the gap between the lack of practicing doctors and the high number of

immigrants who were internationally trained. Involved providing opportunities for

medical practice leading participants to practicing medicine in Portugal

Provided Portuguese language courses focused on technical medical terms that

would help transition immigrant doctors into the Portuguese hospital settings and

situations

Description

The program ran from 2002 until December 2005 and had the goal of helping 120

immigrant doctors, not currently working in the medical profession, to transition back

to their professional careers.

All candidates went through a training period, completed a final exam, and had to

register in the medial council.

Upon the success of the program and the placement of doctors in the labour market,

the program restructured and was no longer needed

4. MATERIALS FOR FOREIGN TRAINED HEALTH PROFESSIONALS

Type of Program Material for Foreign Trained Health Professionals to Learn English

Program Name: Hospital English.com

Target group: ESL health professionals who want to expand their English medical vocabulary in

different health areas and topics

Target group ESL health professionals who want to work in an English speaking health care

setting

Location Online for download and referencing

Description: An online resource centre for downloading material to learn medical English for ESL

health professionals


Name of Program: Englishmed.com

Description: Online multimedia learning course for learning medical terminology and medical

situations in English

Focus of program

Providing tools to improve English with respect to medical vocabulary and topics

through downloading. Clients have access to a number of study groups, career

coaches and workshops to establish a career in the health care industry. Broken

down by profession, situation and relationships to encounter

Location Online for download and referencing

Target group ESL health professionals who want to work in an English speaking health care


APPENDICES



setting


Program Name Good Practice: Cambridge U

Location Book for purchasing on online

Description

Provides Communication skills in English for medical practitioners by focusing on

the language and skills needed to make consultations. The book is divided into five

sections for improving English: verbal, active listening, voice management, non-

verbal communication and cultural awareness

Students learn how to handle a taking a patient’s history, breaking bad news,

examining a patient and describing treatment options as well as dealing with a

range of patients (e.g. Children and elders).

Includes a DVD of interaction between doctors and patients to understand the

environmental and physical skills to understand English usage in different medical

scenarios

Includes a range of material and worksheets for students to reflect and improve their

abilities, such as online worksheets, vocabulary practice activities and reading

activities

Target group Foreign educated doctors who need to learn how to effectively communicate in

English

Focus of program

Use a range of multimedia material to gain communication skills, including audio

CD, worksheets, reading exercises, wordlists and student journaling. They include

referencing of real life scenarios for students to become more confident and be

effective medical practitioners.


Book

Program Name Professional English in Use Medicine

Description

Contains 60 units covering a wide variety of medical vocabulary. Topics include

diseases and symptoms, investigations, treatment, examining and prevention

Introduces general medical vocabulary related to parts and functions of the body,

medical and para-medical personnel, education and training, research, and

presentations

Includes coverage of functional language and communication skills such as Discussing treatment and Giving bad news give students valuable practice.

Location Book for purchase

Target group

Designed as a self-study reference for medical practitioners who need to use

English at work, either in their own country or abroad

Also be used for classroom work for facilitators of an English medical terminology

course or for one-to-one lessons.

Focus of program Covers a wide variety of medical vocabulary that gives learners the confidence and

ability to function in English in a medical environment

5. RESOURCE CENTRES FOR ESL FOREIGN TRAINED HEALTH PROFESSIONALS

Type of Program Resources for ESL Foreign Trained Health Professionals

Region: California

Program Name Partnerships in Communication Training: English for Medical Professionals

Description Teaches terms and topics commonly used in health care through 4 modules and


APPENDICES



Region: California

activities

Provides a interactive activities, giving the learners the opportunity to record

themselves and compare their pronunciation with that of a native speaker.

Location Online through California Workforce Learning Resource Centre

Target group Non-native English speakers who are medical professionals in California

Focus of program

Provide basic skills training and education to ensure California's workforce has the

skills necessary to be productive in the workplace.

Online pronunciation course and tutorial for medical professionals


Region: San Francisco, San Diego, Rhode Island, Boston, Puget Sounds, Maryland, New

York, Texas and Colorado

Program Name Welcome Back Initiative: Integrated Programs, Language and other Assistance

Target group

Medical professionals who have received their formal education and training in a

health field outside of the US, who live in the center’s respective state/area, and

would like to enter the healthcare sector in the United States

Focus of program

To build a bridge between people internationally trained health workers living in the

United States and the provide health professionals with the language skills and

cultural understanding to work in the US health care sector. Clients are provided

with an understanding of what courses, exams and studying is needed to facilitate

this transition into a health care career.

Location International Health Worker Assistance Centres

Description

Recruits and retains foreign trained medical professionals through an information

and resource center. The centre provides orientation, counselling and support

through one-on-one case management guidance to make career goals clear and to

discuss how to meet benchmarks

Assists participants in developing a career pathway plan that builds on their

education, experiences, and skills.

The centre includes a list of agencies that offer advice and services related to

immigration status issues, links to appropriate education programs, orientation

regarding licensing, job announcements, interpreter assistance and study groups,

general information meetings and peer networking groups

ference weicker & company evaluation of the · pdf fileevaluation of the professional...

Documents