Perspectives 2017: Jenna Bright
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This document summarizes the pathway for internationally educated optometrists to become registered and practice optometry in Canada. It describes the six main steps as stops along the yellow brick road: 1) Credential assessment to verify qualifications, 2) Prior learning assessment to evaluate knowledge and skills, 3) Admission to an international optometric bridging program, 4) Completing a bridging program, 5) Passing the national board exam, and 6) Obtaining provincial registration. Approximately 360 graduates have completed the bridging program and become licensed optometrists in Canada, with a 100% employment rate. The program emphasizes participant-focused education, adaptability, and collaboration between schools and regulatory bodies.
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Perspectives 2017: Jenna Bright
- 1. Jenna Bright Waterloo University International Optometric Bridging Program Plenary III: Reflections on the Success of Transition and Bridge Programs for IEHPs
- 2. Following the Yellow Brick Road: Reflections on the Pathway to Canadian Optometric Practice for Internationally Optometric Graduates Presented by: Jenna Bright, OD MSc Program Manager International Optometric Bridging Program
- 3. Optometry in Canada • Doctors of Optometry are independent primary health care providers who provide comprehensive eye examinations that determine both quality of vision and the overall health of the eyes • Approx. 6000 Optometrists in CAN • Provincially Regulated profession • Scope of practice differs provincially
- 4. Optometry Training • Two Canadian Optometry Schools: – University of Waterloo School of Optometry & Vision Science (WOVS) – University of Montreal School of Optometry • Graduates earn a Doctor of Optometry (O.D.) degree upon successful completion of a 4 year degree.
- 5. Background • International Optometric Graduates (IOGs) are defined as individuals educated in Optometry outside of North America. • Historically, WOVS would accept IOGs and place them in the 3rd year of the OD program – Spaces were very limited – Demand was very low
- 6. Background • In the early 2000’s the College of Optometrists of Ontario (COO) approached WOVS about developing a pilot program for IOGs • WOVS received government funding for development and in 2005 the first International Optometric Bridging Program (IOBP) was offered • Agreement with Provincial Regulators to cap IOGs to 40 per year
- 7. Or…”The Pathway to Optometric Registration in Canada for IOGs”… Follow the Yellow Brick Road…
- 8. The First “Stop” Credential Assessment – Past: Administered by IOBP then in 2013 the College of Optometrists of Ontario took it over. – Present: Committee established by Provincial Regulators • WES Authentication • Language Fluency • Academic Credential Assessment – Comparison to WOVS OD Curriculum – Credential Assessment
- 9. The First “Stop” Credential Assessment – Future: Keeping up with “trends” • Develop a process for objectively quantifying work experience, where appropriate • Regulators will need to continuously monitor curriculum developments and changes to scope of practice
- 10. The Second “Stop” Prior Learning Assessment Recognition - Past: In 2005 the IOBP and Canadian Examiners in Optometry (CEO) partnered to develop a PLA to assess the knowledge, skills and judgement of IOGs - In 2013-14 College of Optometrists of Ontario collaborated with Touchstone Institute to develop an evaluating examination PLAR
- 11. The Second “Stop” Prior Learning Assessment Recognition - Present: In 2015 Touchstone Institute offered the first Internationally Graduated Optometrist Examination (IGOEE) - Blueprint consistent with national optometry competency profile developed by CEO - Results are used by the regulators to determine eligibility to apply for a bridging program
- 12. The Second “Stop” Prior Learning Assessment Recognition - Future: Monitor performance within and post IOBP based on IGOEE performance - Curriculum revisions as appropriate - Adjust thresholds as necessary
- 13. The Third “Stop” IOBP Admissions - Past: Meeting minimum thresholds on the PLA guaranteed placement into a bridging program. Present: Demand>Supply - Demographics are changing (greater number of returning Canadians) - Admissions committee ranks candidates’ IGOEE scores and sends offers of admission to highest ranked applicants ADMISSIONS
- 14. The Third “Stop” IOBP Admissions - Future: - Program capacity - Currently working with Touchstone Institute to develop an occupation specific language assessment as an additional criteria used to rank candidates for admissions purposes
- 15. The Fourth “Stop” Bridging Programs - Bridging One - Past: 4 weeks - Present: 10 week didactic lectures/labs + 2 week examination period + 4 week externship = 16 weeks - Bridging Two - Past & Present: 1 year (28 weeks didactic lectures/labs/exams + 2-10 week externships blocks) BRIDGING PROGRAMS
- 16. The Fourth “Stop” Bridging Programs - Future: - Research & Development regarding integrating IOBP within the Doctor of Optometry program - Students would graduate with an O.D. degree - Continuous curriculum development
- 17. The “Fifth & Sixth Stops” • #5 Canadian Optometry Board Examination • #6 Provincial Registration – Jurisprudence examination We’re almost there!
- 18. The “Emerald City” aka “Canadian Optometric Practice”
- 19. IOBP Graduates • Approx. 360 IOGs have successfully completed the IOBP and are licenced to practice Optometry in Canada • 100% employment rate across Canadian province
- 20. Reflections • Participant-Focused Education • Adaptability • Communication & Collaboration
- 21. Thank you!
- 22. 2017 Perspectives Symposium March 2, 2017 #Perspectives2017
Editor's Notes
- Good morning, I would like to start off by thanking Touchstone Institute for this opportunity to share with you my experiences as the Program Manager of the International Optometric Bridging Program (IOBP). The registration process for internationally educated eye care professionals has evolved over time, and as I was reflecting back on this process in preparation for todays presentation, I was inspired to use an analogy of the yellow brick road from the wizard of oz to assist me in guiding you along the pathway internationally education optometric graduates must follow in order to practice optometry in Canada.
- Not all of you may be familiar with the profession of optometry, so, for background purposes Doctors of Optometry are independent primary health care providers and represent the front line of vision health. Being a primary care provider, referrals to an optometrist are not required. Optometrists determine refractive error, binocular vision function and are able to diagnose ocular manifestations of systemic conditions such as diabetes and high blood pressure . Optometrists treat and manage a wide range of conditions. Typically, optometrist work in private practice, however some do work in hospitals, community health centres, corporate locations, as well as research, teaching and administration. According to the most recent report from the CAO, there are approx. 6000 ODs in CAN. Optometry is a regulated profession and the scope of practice differs provincially. The biggest differences in scope tends to be around prescribing therapeutics.
- In Canada, a Doctor of Optometry completes a minimum of 3 years of undergraduate study in science, followed by a four year Doctor of Optometry degree. Each year, approximately 130 graduates from the only two Canadian schools of optometry (University of Waterloo and Université de Montréal). In addition, there are international graduates and Canadian graduates from US schools of optometry who return to Canada to practice. Because US optometry schools are accredited by the same body as CAN ones, US optom graduates are not required to complete bridging education. UW graduates 90 students per year Montreal graduates 42 students per year
- For the purpose of this presentation, I will refer to International Optometric Graduates as IOGs who are individuals educated in optometry outside of north America. Historically, Approx. 20 + years ago the University of Waterloo School of optometry would accept IOGs and place them in year 3 of the optometry program. At that time however, spaces were very limited, and demand from IOGs was also very low.
- As the demand from IOGs rose, and it became evident that these individuals were having a hard time passing the CAN board examsthe COO approached WOVS to develop a pilot program. Seed money was provided from the Ontario college as well as other regulators and this development was made a reality when a pilot program was delivered in 2003. Furthermore, WOVS received government funding for the development of a formal bridging program, and in 2005 the first program was offered. 2005 first Bridging One Program 4 weeks in length 2007 first Bridging two Program One year in length
- As mentioned previously, I am going to use the yellow brick road as a guide to the pathway IOGs must take in order to be licensed to practice optometry in Canada. I’m using the words “stops:” to refer to checkpoints and in no way am I inferring a negative association Along the way I will share perspectives on the evolution of each of these stops and anticipated future endeavours.
- The first checkpoint is the credential assessment phase. From about 2005 until 2013 the IOBP administered credentialing and in 2013 the COO took it over. In recent years a committee established by the provincial regulators was formed and now this committee is responsible for credentialing. In all cases the credential assessment has compared training and experience of IOGs to the WOVS OD Curriculum. At Present, this phase also includes a WES authentication and language fluency. Change from past to present precipitated by perceived conflict of interest One challenge during the transition was a time lag for applicants to be assessed
- One of the challenges currently faced is a fair mechanism for objectively quantifying work experience. Going forward, it will be important for the credentialing committee establish such a mechanism and continuously monitor curriculum developments and changes to provincial scopes of practice and revise the assessment template accordingly.
- The second stop along the pathway is the PLAR. At its inception, the IOBP partnered with the Canadian Examiners in Optometry (CEO) , which is the organization who administers the national board examination, to develop a PLA to assess the knowledge, skills and judgement of IOGs. The PLA was based on competencies assessed on the board exams. In approx. 2013-14 the COO collaborated with Touchstone institute to develop an evaluating examination
- In 2015 Touchstone Institute offered the first IGOEE - which I will refer to as the evaluating exam. The blueprint of this examination follows the national optometry competency profile that was developed by CEO in recent years. Similar to results of the PLA, results from the evaluating examination are used to determine eligibility to apply for a bridging program.
- Looking ahead, it will be important to monitor the performance within the IOBP and post IOBP based on IGOEE performance data. If necessary, curriculum reviesions will need to be considered. It may also be necessary to adjust thresholds for program admissions.
- The third stop is IOBP program admissions. In the past, meeting minimum thresholds on the PLA pretty much guaranteed a candidate would be given an offer of admission. As demand for the program exceeded capacity an admissions committee and ranking process was created by the IOBP. During the transition from receiving PLA – IGOEE results the admissions committee had to develop a fair process for comparing and ranking 2 very different sets of data. Over the years we have seen a shift in demographics of our applicants and today see a much higher amount of returning Canadians who were educated outside of N.America, most notably in the UK. At present, the admissions committee ranks individual IGOEE scores and send offers of admission to the highest ranked applicants. A government requirement for program entry is Canadian citizenship, PR status, or convention refugee. If Q&A- Consulted with statistician process recommended to us was to rank each set of results and equate 2nd tops and 2nd bottom spots to develop a conversion equation – similar to converting Celsius to Fahrenheit
- As previously mentioned, we are seeing change in the demographics of our applicants and going forward the IOBP expects to face challenges around the number of eligible participants for each program and program capacity A current initiative the IOBP is working on, in collaboration with Touchstone Institute, is an occupation specific language assessment. A pilot administration of this test will be conducted in the early Spring of this year. We are hoping the test will yield robust results that can be used as an additional factor when making admissions decisions. Furthermore, the regulators may decide in the future that this assessment is an acceptable language fluency test during the earlier academic credentialing phase.
- The fourth stop is enrollment in a bridging program. The IOBP offers two bridging programs. The Bridging One program was designed to meet the needs of IOGs with minimal gaps in knowledge, skill or judgement. This program started off as a 4 week program and over the years, with increases in scope of practice and enhancements to curriculum, is now a 16 week program which includes a 4 week externship placement in a Canadian optometric practice. The Bridging two program was developed as a 1 year program and remains so…minor program revisions have occurred over time. Academic rigor has increased in both programs consistent with university policies and students must successfully pass all program components before they receive a certificate of completion.
- Given pressure from various stakeholders, the IOBP and WOVS are exploring the advantages and disadvantages of integrating the IOBP within the Doctor of Optometry curriculum. In some other jurisdictions, specifically the united states, advanced standing programs are common. UW institutional representatives are currently reviewing university wide policies and investigating whether there would be funding implications with such a change.
- The next two checkpoints come after successful completion of a bridging program. IOGs must pass the Canadian board examination which is administered by CEO. The format of the board examinations has changed over the years and in fact a new OSCE based examination is being used later this year. Once candidates have successfully complete the board exams they must apply to a provincial regulatory body and meet the individual province requirements, for example, pass a jurisprudence examination. Q&A: the original impetus for the bridging program was to improve success rates on the entry to practice examination – we have been successful in improving those rates, however we are not yet at the stage where IOGs have the same performance as North American trained graduates. This presents us with the opportunity to make further developments and improvements to the education and training we provide to IOGs. To improve that, integration with WOVS curriculum which would likely be longer than current B2 program. Out fo privacy concerns, CEO now provides us with limited information and I wouldn’t like to speculate on how well our graduates compare. From the CEO annual report 2015-16 annual report CAN pass rates 90.4% US 85.1% Intl 79.5%
- Once IOGs have successfully passed all the stops they become registered and licensed to practice optometry in Canada….they have reached the emerald city!
- To date, approx. 360 IOGs have successfully completed a bridging program and are licensed to practice optometry in Canada. Many graduate and work as associates and some start practices of their own or buy an existing practice. We are proud to see some of our graduates contributing back to the profession and our program as clinical instructors and supervisors and association/college representatives.
- I’ve now walked with you along the yellow brick road and introduced you to the process that IOGs must follow in order to obtain licensure in Canada. When I reflect on this process there are definitely a lot of lessons we have learned over time. One of the biggest opportunity for educators is providing participant focused education. Over time the application process, credentialing and prior learning assessment have evolved to better assess the applicants and determine eligibility for a bridging program. Ensuring bridging education meets the needs of its participants is critical. During our programs we provide opportunities for the students to give feedback on the registration process, individual courses and labs, externship placements and board examinations. Not only is it important to listen to the feedback given but its important to take action and make program enhancements. It is important for bridging educators to keep up with the changes in scope of practice and not be afraid to be leaders in education. The educational needs to internationally trained healthcare providers may be very different from those who are Canadian trained. A notable program enhancement made by the IOBP was the inclusion of communication labs working with standardized patients. In these labs the IOGs get to interact with trained patients in mock clinical scenarios and have the opportunity to get feedback from clinical instructors. This has proven to be an invaluable experience both as preparation for the board exams but also helps the students enhance their communication skills. In this regard we are ahead of the doctor of optometry program which has yet to undertake such an initiative. Adaptability is a key opportunity for program success. It is important to address the needs of your stakeholders which may include the students, institution, regulators, association but it is also important to not lose sight of your mission as an educator. Open communication and collaboration, keeping the participants and their educational needs should be top priority.