Ivy Lynn BourgeaultUniversity of Ottawa, Canadian Institutes of Health Research

Plenary IV: Research on Impacts and Outcomes

CIHR/IGH CHAIR IN GENDER, WORK & HEALTH HUMAN RESOURCES

Perspectives on Successful Transitions

for Internationally Educated Health

Professionals: Impact & Outcomes

Overview

• Scoping Review of the Literature on IEHPs– Nursing– Medicine

• New research on Nursing• New research on IEHP Bridging Programs• Emerging research on Medicine

• Acknowledgements to Christine Covell, Elena Neiterman, Zubeida Ramji & Maria Mathews

SCOPING REVIEW

Scoping Review of Literature on IEHPsSearch• Academic literature - CINHAL, EMBASE, and PubMed

electronic databases• Grey literature- Canadian Electronic Library and the

Canadian Health Human Resources Network (CHHRN) Library

• published from 2001 to 2013; n=407 reflecting recent trends

Analysis• Standardized literature extraction toolConsultation• An advisory council of stakeholders was consulted

throughout the project

IENs

IEMs

IMGs

IEHPs

IEOTs

IERTs

ITDsITP

IEMRT

IEPT

MLTs

0

20

40

60

80

100

120

140

160

180

104

4

167

80

9 2 5 124 5

15

Frequency of Publications by Profession (N=407)

Num

ber o

f Pub

licat

ions

Alberta

Atlanti

c Prov

inces

British

Colu

mbia

Manito

ba

Newfou

ndlan

d & La

brado

r

Nova S

cotia

Ontario

Pan C

anad

ian

Prince

Edw

ard Is

land

Quebe

c

Saska

tchew

an

Wes

tern P

rovinc

es &

Territo

ries

0

50

100

150

200

250

292 12 4 15 10

77

233

2 7 14 2

Geographic Distribution of Publications (N=407)

Num

ber o

f Pub

licat

ions

Number of Sources by Year of Publication(N = 407)

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 20120

10

20

30

40

50

60

70

Num

ber o

f Pub

licat

ions

Sources per Empirical Method (n= 189)

Qualitative

Quantita-tive

Mixed Methods

(n=62; 33%)

(n=91;48%)

(n=36;19%)

Narrative Themes Used for Analysis

Pre-immigration activities and programs

Early arrival activities and programs

Credential recognition and professional recertification

Bridging and residency training programs

Alternative paths to professional integration

Workplace integration

Pre-Im

migrati

on A

ctivit

ies &

Prog

rams

Early A

rrival

Activit

ies &

Prog

rams

Creden

tial R

ecog

nition

& P

rofes

siona

l Rec

ertific

ation

Bridgin

g & R

eside

ncy T

rainin

g P

rogram

s

Alterna

tive P

aths t

o Inte

gratio

n

Work

place

Integ

ration

020406080

100120140160180200

79

41

190

36 27

123

Frequency of Themes (N=496)

Scoping Review of Literature on IEHPs

• Covell, Neiterman & Bourgeault, HRH, 2016• Literature on IMGs and IENs dominates• Most literature reports on empirical studies• The overarching concern is with workplace integration,

professional recognition and bridging programs. • Nursing dominates the literature about pre-immigration

activities and programs whereas the literature about early arrival activities and programs, professional recertification and workplace integration is dominated by medicine.

• Trends for IEHPs in the allied health professions is unclear

Gaps in Literature

Diversity within the IEHP group and how they are different or similar to other skilled workers migrating to Canada.

Sociocultural integration of IEHPs and their families. The complete range of service offered by immigration settlement

organizations. The effectiveness of policies and programs to address barriers to

credential recognition and professional recertification. Commonalities and effectiveness of various bridging and residency

program models, curricula. Retraining of IEHPs into other healthcare professions and alternative

paths to IEHP workforce integration. Role of employers in facilitating workplace integration.

Scoping Review of Literature on IENs

• Covell, Neiterman & Bourgeault, CJNR, 2014• Gaps in the Evidence About IENs

– Effectiveness of resources available to support the professional recertification of IENs.

– Formal literature describing the direct recruitment initiatives or their long-term outcomes.

– The processes IENs use to search for work, the role of the employers, including retention strategies.

– Language proficiency on IENs’ professional recertification, workforce, workplace integration and career advancement.

Scoping Review of Literature on IMGs

• Neiterman, Covell & Bourgeault forthcoming Healthcare Policy

• N=148 sources• Themes predominating in the literature are

– credential recognition/professional recertification;– bridging and residency training; and – workplace integration

• The gaps are in:– pre-immigration and early arrival activities, and– alternative paths for integration for those IMGs who

do not pursue medical licensure.

NEW & EMERGING RESEARCH

New Research on Nursing• Zubeida Ramji (2016) Beyond Transition:

Understanding Workplace Integration of IENs

New Research on Nursing

New Research on IEHP Bridging Programs• Sattler P, et al. Multiple Case Study Evaluation of

Postsecondary Bridging Programs for IEHPs. Higher Education Quality Council of Ontario, 2015.

• A multiple case study analysis of the most promising practices for bridging education through 7 programs: MLT/MLS, MRT/DMS, RT & PTL

• The key challenges include developing curricula tailored to participants’ needs, identifying appropriate format for program delivery, obtaining clinical placements for participants and achieving financial sustainability.

• The most effective bridging programs are those that are accessible and flexible in content and format.

Emerging Research on Medicine

• Mathews M, et al forthcoming in CMAJ Open, HRH, HCP, CFP…

• Drawing upon the relatively underutilized IMG database• Realization of Entry-to-Practice Milestones of Canadians

who Studied Medicine Abroad and Other International Medical Graduates

• CSA and non-CSA IMG’s performance at the various stages of the credentialing and licensing process and their contribution to the supply of physicians in Canada

Key Take Home Messages

• We know a lot about some themes for nursing and medicine

• We know less about other critical themes for these professions and very little about other IEHPs

• Research also needs to keep pace with changing policies and practices

• Stay tuned …

2017 Perspectives SymposiumMarch 2, 2017

#Perspectives2017