Moving Forward Integration of IPGs

Integration of InternationalPharmacy Graduates into the

Canadian Pharmacy Workforce: Barriers and Facilitators

FINAL REPORT

January 2008

Prepared for:Moving Forward: Pharmacy Human Resources for the Future

Prepared by:R.A. Malatest & Associates Ltd. and Ms. Marie Rocchi

Funded by the Government of Canada’s Foreign Credential Recognition Program

© 2008 Canadian Pharmacists Association

The Moving Forward initiative is funded by the Government of Canada's Foreign Credential Recognition Program.

The opinions expressed in this publication are those of the author and do not necessarily reflect those of the Government of Canada.

Integration of International Pharmacy Graduatesinto the Canadian Pharmacy Workforce: Barriers and Facilitators

FINAL REPORT

January 2008

Prepared for:Moving Forward: Pharmacy Human Resources for the Future

Prepared by:R.A. Malatest & Associates Ltd. and Ms. Marie Rocchi

How to cite this document:

Management Committee, Moving Forward: Pharmacy Human Resources for the Future.Integration of International Pharmacy Graduates into the Canadian Pharmacy Workforce:Barriers and Facilitators. Ottawa (ON). Canadian Pharmacists Association; (2008)

Integration of International Pharmacy Graduates into the Canadian Pharmacy Workforce:Barriers and Facilitators

Table of Contents

Executive Summary........................................................................................................

Overview of Moving Forward: Pharmacy Human Resources for the Future ............1

Acknowledgements ......................................................................................................2

Acronyms Used in this Report .....................................................................................4

Introduction .................................................................................................................5Background to the Project...............................................................................................5Purpose and Scope of Study............................................................................................6Overview of Report..........................................................................................................7

Section 1: Research Approach and Methodology ........................................................8Research Design ..............................................................................................................8Specific Research Components .......................................................................................8Research Considerations ...............................................................................................12

Section 2: Findings.....................................................................................................13Settling in Canada..........................................................................................................13

Profile of IPGs Settling in Canada.............................................................................13Deciding to Settle in Canada ....................................................................................16Expectations of IPGs in Settling in Canada ..............................................................16Sources of Information .............................................................................................16Information Lacking in the Country of Origin .........................................................17

Licensing and Registration ............................................................................................18Information About the Licensure Process ................................................................19Number of IPGs Seeking Licensure ..........................................................................19Performance of IPGs in the PEBC National Pharmacy Examinations .......................20Number of Attempts at PEBC Examinations.............................................................21Challenges Faced by IPGs in the Licensing and Registration Process ......................22Additional Programs or Services Needed to Support IPGs on the Path to Licensure ......................................................................................................24Supports Being Offered by Employers .....................................................................26Enablers of Success in the Licensing and Registration Process................................26Perceived Effectiveness of Licensing Process............................................................27

Bridging Programs.........................................................................................................28Current Bridging Programs Available for IPGs .........................................................28Awareness and Usage of Bridging Programs.............................................................28Reasons IPGs Do or Do Not Participate in a Bridging Program ...............................32Perceived Effectiveness of Bridging Programs ..........................................................34Perceived Gaps in Program Delivery.........................................................................35

Working in Canada ........................................................................................................36Profile of Employment of IPGs .................................................................................36Perceptions of Employers .........................................................................................39Benefits of Hiring IPGs .............................................................................................43Barriers or Challenges to IPG Success......................................................................44Facilitators of IPG Success ........................................................................................46

TABLE OF CONTENTS

Section 3: Key Findings..............................................................................................49Settling In Canada .........................................................................................................49Licensing/Registering to Practise as a Pharmacist in Canada ........................................49Bridging Programs.........................................................................................................50Working in Canada ........................................................................................................51

Research Appendices..................................................................................................52Appendix A: Bibliography .............................................................................................54Appendix B: Survey Questionnaires .............................................................................56Appendix C: Interview Guides ......................................................................................57Appendix D: Focus Group Moderator Guides..............................................................58Appendix E: Template for Bridging/Support Program Fact Sheets...............................59


EXECUTIVE SUMMARY

IntroductionThe study of issues surrounding the Integration of International Pharmacy Graduatesinto the Canadian Pharmacy Workforce was designed to describe barriers and facilitatorssurrounding the licensing and registration of international pharmacy graduates (IPGs) andtheir integration into Canadian pharmacy practice. The study was commissioned as part ofMoving Forward: Pharmacy Human Resources for the Future. This initiative is acollaboration of eight national pharmacy stakeholders, including the CanadianPharmacists Association, and is examining the factors contributing to pharmacy humanresources challenges in Canada.

The objectives of the research are to provide a profile of IPGs in Canada, anunderstanding of the information, supports, and programs that are available to IPGs, thechallenges they face in becoming licensed to practice and integrated into the Canadianpharmacy workforce, and what further supports may be needed to help alleviate thesechallenges. For the purpose of this study, IPGs are defined as individuals living in Canadawho completed their undergraduate pharmacy education in a country other than Canadaor the United States of America.

This research project collected data from many different sources in order to provide acomprehensive overview of IPG human resources issues. The research undertaken included the following: • A national survey of IPGs (n=1067); • A survey of pharmacy employers (owners, managers, and directors) (n=315); • In-person or telephone interviews with key informants from the provincial pharmacy

regulatory authorities, provincial associations, and large pharmacy chains (n=27); • Interviews with providers of bridging programs and courses (n=10); • Four focus groups with IPGs; • Two focus groups with employers, and • A literature and statistical review.

Settling in CanadaThere is currently no comprehensive source of data on the number or proportion of IPGsin the Canadian pharmacy workforce. However, recent data from the Canadian Institute ofHealth Information report that the percentage of licensed practising pharmacists inOntario and Alberta who are IPGs is 27% and 8%, respectively.

According to information from Citizenship and Immigration Canada, approximately 500 new immigrants come to Canada each year stating that they intend to work aspharmacists. This figure includes only “economic class” immigrants and does not includeother populations of newcomers to the country. IPGs most often arrive in Canada fromSoutheast Asia (30%) or the Middle East (26%). Common countries of origin include India,Egypt, Pakistan, the Philippines, Iran and Jordan. The majority of IPGs settle in Ontario.

Most IPGs come to Canada with undergraduate degrees in pharmacy. In addition, 14% ofsurveyed IPGs indicated that they had completed a master’s degree, 8% had completed a


Executive Summary


PharmD degree, and 3% had completed a PhD. It is not known if these graduate degreeswere entry-to-practice requirements in the IPG’s country of orgin. The majority (85%) ofIPGs have practised as pharmacists in their country of origin before settling in Canada.

IPGs generally appear to be making their own decision to settle and work in Canada. IPGsconsult a variety of different sources in making these decisions. Often, they rely on theInternet, accessing information through the websites of the Pharmacy Examining Board ofCanada (PEBC) and provincial pharmacy regulatory authorities (PRAs), among others.Family and friends already in Canada are also important sources of information for IPGs.

Decisions on where to settle in Canada are often being made based on where family andfriends are already living in Canada. IPGs generally choose to initially settle in large cities,where they feel they and their family members can more easily integrate into Canadiansociety, and where they believe that they are more likely to find pharmacy jobs. Some IPGsare making decisions based on incomplete information or incorrect assumptions. Forexample, while many IPGs feel that they should settle in the largest cities where there arelikely to be more job opportunities, many key informants stated that most opportunitiesfor pharmacist jobs are located in smaller cities or towns.

IPGs settling in Quebec are generally more proficient in French than English, and move tothat province in order to be able to work and live in French.

Over three-quarters (78%) of IPGs who settle in Canada expect to eventually work aspharmacists. Some IPGs have no particular expectations related to their own career, andmove primarily for reasons related to family.

Summary of Settling in Canada• While IPGs come from many different areas and backgrounds, they are typically from

Southeast Asia or the Middle East, possess an undergraduate pharmacy degree astheir highest level of education, and have experience working as a pharmacist.

• Before settling in Canada, IPGs most often find information about becoming apharmacist in Canada using the Internet, or through friends and family already livingin Canada.

• Most IPGs settling in Canada expect they will eventually work as pharmacists inCanada, and most have already practised as pharmacists in their previous career.

Licensing/Registering to Practise as a Pharmacist in CanadaIn order to practise as a pharmacist in a pharmacy, IPGs must become licensed (orregistered) to practise by the pharmacy regulatory authority of their chosen province. Thesteps involved in this process, and their order, vary by province, with Quebec’s licensingprocess being significantly different than that of the other provinces. Generally, however,IPGs must submit their documents for evaluation to the Pharmacy Examining Board ofCanada (PEBC) for verification of identity and comparability of university credentials,undertake an Evaluating Examination, complete a two-part Qualifying Examination (whichincludes a multiple choice exam and a simulated practice component called the ObjectiveStructured Clinical Examination, or OSCE), demonstrate English (or French) languagefluency, undertake an apprenticeship period (known as structured practical training), andpass a provincial examination concerning issues of jurisprudence. The first two steps(Document Evaluation and the Evaluating Exam) can be completed outside of Canada,

Executive Summary


whereas the other steps are usually completed within the country. The PEBC isresponsible for the assessment of graduates in all provinces except Quebec.

In Quebec, IPGs undergo a foreign credential recognition process through a provincialcommittee, which assesses their prior education and determines which courses they mustcomplete at a Quebec university to achieve equivalency with Quebec pharmacy graduates.They must also demonstrate French language fluency and undertake structured practicaltraining.

IPGs are generally reliant on the Internet for their information about the various steps ofthe licensure process, although some IPGs receive assistance directly from the PEBC, thePRAs, or from employers and peers.

During the time period of 2002-2006, an annual average of 876 unique, individual IPGspresented their documents for evaluation. During the same time period, an annualaverage of 694 unique IPGs attempted the Evaluating Examination; an average of 524 IPGsattempted the Qualifying Examination Part I (the multiple choice questionnaire) and anaverage of 433 IPGs attempted the Qualifying Examination Part II (the OSCE). Candidatescan have up to four attempts to pass each examination. During the years 2002 to 2006,combining all examination sittings, the IPG pass rate was 59% for the EvaluatingExamination, 48% for the Qualifying Examination Part I, and 45% for the QualifyingExamination Part II. While only a quarter (26%) of unique IPGs made multiple attempts atthe Evaluating Examination, almost one-half of unique IPGs made multiple attempts atboth parts of the Qualifying Examination during that period (46% and 48% respectively).By comparison, less than 10% of domestic graduates generally make more than oneattempt at the Qualifying Examination.

IPGs feel that the PEBC Qualifying Examination, particularly the OSCE, is the mostdifficult part of the licensing process. About three-quarters of surveyed IPGs feel that theQualifying Examination Part I (74%) and Qualifying Examination Part II (77%) were“difficult” or “very difficult”, with 19% rating Qualifying Examination Part I and 28% ratingQualifying Examination Part II as “very difficult”, respectively. The Evaluating Examinationwas also rated as “difficult” or “very difficult” by a majority (58%) of IPGs. Finding apractical training position was rated as “very difficult” by 26% of IPGs, and “difficult” by28% of IPGs.

IPGs often find the licensure process to be time-consuming and costly. The average amountof time for the licensure process was 26 months, with 58% of IPGs who had been licensed inCanada indicating that the process had taken two years or more. In Quebec IPGs arerequired to attend courses at either of the province’s two university faculties of pharmacy.Consequently, there is a strong demand for these courses, and some IPGs report that thetime required to achieve educational equivalency is often considerable. Costs accrued byIPGs as they undertake the necessary steps to achieve licensure may be considerably higherthan those of Canadian graduates. They can include fees for evaluation processes, nationalexaminations (often repeated), and bridging or support training.

Both IPGs and employers feel there is a need for more bridging programs and courses tohelp IPGs through the licensure process. IPGs generally felt that more opportunities forpractical/work experience were needed, whereas employers generally suggested thatlanguage/communication skills training were most critical.

Executive Summary


Summary of Licensing/Registering to Practice as a Pharmacist in Canada• The pass rates of IPGs on the Qualifying Examination are low compared to those of

Canadian graduates.• A large percentage of IPGs make multiple attempts at the Evaluation and Qualifying

Examinations.• IPGs often take two years or more to become licensed to practise as a pharmacist.• IPGs identified the Qualifying Examination Part II (the OSCE) as the most difficult

step in the licensing process, but generally find all PEBC examinations to be difficult. • Both IPGs and employers feel that additional programs or supports are needed to

support IPGs on the path to licensure. IPGs are most often looking for programs andsupports that provide practical experience, whereas employers feellanguage/communication skills support are most critical.

Bridging Programs and CoursesAcross Canada, there are a number of bridging programs and courses available to helpIPGs become licensed to practise as pharmacists in Canada. These programs helpinternationally trained pharmacists adapt to the various aspects of practice in theCanadian context. For the purposes of this study, bridging programs are defined as formal,post-degree programs of study designed to address gaps between an IPG’s education orexperience and the standards of pharmacy practice in Canada. This research identifies anddocuments 9 such programs. These include programs for IPGs at the University of Toronto(U of T) and the University of British Columbia (UBC), as well as programs offeredthrough private trainers in Ontario, Alberta, Manitoba, and Nova Scotia.

Bridging programs are generally publicized through provincial pharmacy regulatoryauthorities, provincial pharmacy associations, the PEBC, employers, and immigrantsettlement agencies. About one half of IPGs across Canada are aware of the programs,even though these programs are generally accessible only to those IPGs located in oraround the selected cities where the courses are offered. No IPG bridging programscurrently exist in the province of Quebec, although key informants reported a programwas currently under development.

While 60% of IPGs said they had never taken a bridging program and had no plans toregister in one in the future, interviews with the representatives from the programsindicate that the number of students enrolled in these programs is on the rise, and willlikely continue to grow in the future. Although geographic accessibility is one explanation,most IPGs who are not taking bridging programs (51%) stated they did not take theprogram because they simply did not feel a need to do so. Other reasons included notbeing aware of the programs (27%), or lacking the money required to take the program(17%). Many IPGs find the cost of the bridging programs, $10,000 or more for the mostextensive courses, to be prohibitive.

Those IPGs who do take bridging programs feel the programs are effective in a variety ofways. Most IPGs who had taken the programs stated that the programs were “effective” or“very effective” in providing information on pharmaceutical care (83%), appliedtherapeutics (80%), roles and responsibilities of pharmacists in Canada (79%), and onother topics. The programs also report considerable success rates among programcompleters in subsequently becoming licensed to practise.

Executive Summary


Summary of Bridging Programs and Courses• Nine bridging programs and courses specifically for IPGs from across Canada were

identified and documented. These vary from intensive university-based programs toOSCE preparatory courses.

• Bridging programs and courses are generally seen as beneficial to the IPGs whoparticipate in them.

• Not all IPGs have access to the existing bridging programs. The existing programs arenot available in many areas of the country, and those that exist can be prohibitivelyexpensive.

• A large proportion of IPGs feel they do not need to take bridging programs.

Working in CanadaThe majority of IPGs (78%) expect that they will eventually work as pharmacists inCanada, and the majority have tried to work as either pharmacists (72%) or as pharmacytechnicians (61%) since arriving in Canada. Despite the many challenges of settling in anew country and becoming licensed to practice as pharmacists, 70% of surveyed IPGsreported that they had worked as pharmacists in Canada at some point since settling inCanada.

Almost half (46%) of IPGs also indicated that they had at some point worked as pharmacytechnicians since settling in Canada. This is sometimes an interim step on the path tobecoming a pharmacist, or as a second choice if they have not been able to realize theirgoal of working as a pharmacist in Canada. Others have chosen to work in thepharmaceutical industry where license/registration is not generally required.

Further, 44% of pharmacy employers indicated that they had hired at least one IPG duringthe past three years. Employers generally offer employment to IPGs who are permanentresidents (landed immigrants), or to those who have become Canadian citizens.Employers also typically offer employment most often to IPGs who have successfullycompleted the PEBC Evaluating Exam, or have been practising in Canada for up to fiveyears. Over one-third of employers however indicated that they were not aware of theimmigration status (25%) or the stage in the licensure process (12%) of IPGs they havehired.

IPGs are finding employment in all types of pharmacies, including chain, banner, or franchise pharmacies (51% of IPGs who had been employed in Canada); independent community pharmacies (34%); health care facilities (12%); or other types of pharmacies (2%).

While IPGs are often employed in larger cities, a significant proportion of IPGs find workin mid-size or smaller cities as well. Only 37% of IPGs who have worked as a pharmacist inCanada reported that their pharmacy was located in a city of more than 500,000 people,with the remainder being in smaller centres. Many IPGs are resettling within Canada towork as pharmacists: 31% of IPGs who had worked as pharmacists had to move fromwhere they first settled in order to find employment as a pharmacist. While many IPGswho settle in smaller centres for work thrive in their new communities, some are morecomfortable in larger centres, where they more often have the support of their culturaland/or religious communities.

Executive Summary


Employers also do not generally appear to see particular benefits to hiring IPGs overdomestic graduates. However, a somewhat higher proportion of employers agreed thandisagreed (39% versus 17%) that IPGs are generally more experienced than new Canadiangraduates. Employers do not generally agree that IPG employees provide access to newpatients/clients (24% agreeing versus 27% disagreeing), and there appears to be limitedawareness of the cultural benefits that IPGs can bring to pharmacies.

Employers do not generally appear to feel that IPGs require more time to supervise ortrain than domestic graduates. While key informants felt that this can be a concern foremployers, and particularly for preceptors, this was not evident in the employer surveyresults. Most employers who reported that they had not hired any IPGs stated that this waslargely the result of not having had any recent open positions or any IPG applicants.

Still, most employers felt that barriers to success for IPGs did exist, particularly related tolanguage and communication skills. The top barriers to IPGs’ success identified byemployers were lack of proficiency in communicating effectively with patients and clients(67% of employers stated it was a barrier for IPGs), lack of proficiency in spoken Englishor French (66%), lack of proficiency in written English or French (60%), and lack ofproficiency in communicating effectively with other pharmacy staff and other health careproviders (55%).

The changing, and expanding, role of pharmacists in the Canadian health care system wasalso often cited as a challenge for IPGs. The current pharmaceutical care model in Canadarequires a high level of patient consulting and advising, and many IPGs are typically nottrained to practise according to this model.

Summary of Working in Canada• Despite the challenges of licensure and settling in Canada, most IPGs appear to be

finding work in pharmacy.• Many IPGs are finding work as pharmacy technicians in Canada, often either as an

interim step in the process of becoming pharmacists, or because of difficultiesbecoming licensed or finding employment as pharmacists.

• While IPGs face many challenges to success in the Canadian pharmacy workforce,communication skills are seen by employers as particularly severe barriers.

• Differences in the culture of pharmacy practice are also perceived as significantchallenges to IPG success. The role of pharmacists in Canada is often different than inother countries, leading IPGs to have to adapt to new professional roles andresponsibilities.

• Employers do not see particular advantages or disadvantages to hiring IPGs.

Executive Summary

Overview of Moving Forward: Pharmacy Human Resources for the Future

One of the most urgent crises facing Canada’s health care system today is the appropriatemanagement of health human resources. Pharmacists are a high-priority health humanresource at many levels — involving patient care, drug supply management, healthinstitutions, the health system and population health needs. Pharmacists have a key role toplay at all these levels in ensuring pharmaceuticals are used appropriately, safely andprovide optimal benefits.

Serious challenges are facing the pharmacy sector’s efforts to optimize the management ofits available human resources. These include the evolution of pharmacists’ and pharmacytechnicians’ role in health care delivery, recruitment and retention difficulties andcomplexities in integrating international pharmacy graduates. A failure to addresspharmacy human resource challenges will compromise the ability of the profession torespond to these new demands and its ability to fully address the safe and appropriate useof drugs in Canada. There is, therefore, an urgent need to understand the factorscontributing to these human resources pressures and strategize potential solutions.

A collaborative of eight national pharmacy stakeholders, including the CanadianPharmacists Association (secretariat for the project), the Association of Deans of Pharmacyof Canada, the Association of Faculties of Pharmacy of Canada, the Canadian Association ofChain Drug Stores, the Canadian Association of Pharmacy Technicians, the CanadianSociety of Hospital Pharmacists, the National Association of Pharmacy RegulatoryAuthorities and the Pharmacy Examining Board of Canada has partnered together to carryout Moving Forward: Pharmacy Human Resources for the Future. Funded by theGovernment of Canada’s Foreign Credential Recognition Program, Moving Forward is anin-depth examination of the factors contributing to pharmacy human resources challengesin Canada. It will offer recommendations to ensure a strong pharmacy workforceprepared to meet the current and future health care needs of Canadians.

Through a series of investigations and consultations, Moving Forward will:• Develop a comprehensive understanding of the pharmacy workforce in Canada and

the factors that influence its structure and the skills and competencies of its members;• Identify and analyze the short- and long-term human resource planning challenges

facing the pharmacy sector, including those specific to IPGs, and• Offer recommendations for these challenges.

The optimal management of pharmacy human resources requires more than justinformation; it requires planning. The recommendations developed by Moving Forwardwill be used by stakeholders at local, regional, provincial, territorial and national levels todevelop their pharmacy human resources management plans. The findings contained inthis report represent the results of Moving Forward’s research on the Integration ofInternational Pharmacy Graduates into the Canadian Pharmacy Workforce: Barriersand Facilitators.

Overview of Moving Forward: Pharmacy Human Resources


1

© 2008 Canadian Pharmacists Association2

Acknowledgements

The Moving Forward partners would like to express their appreciation to all the individuals whose participation in this research contributed to its success. Moving Forward wishes to especially thank the many people who kindly took the time to participate in surveys, focus groups, and interviews.

This research study was conducted by R.A. Malatest & Associates Ltd. and Ms. Marie Rocchi. Invaluable assistance was provided by the Pharmacy Examining Board of Canadaand the Ontario College of Pharmacists. The researchers were assisted by the Moving Forward Management Committee, National Advisory Committee, an IPG Working Groupand numerous expert advisors. These contributors include:

Management CommitteeKevin Hall (Moving Forward Co-Chair), Winnipeg Regional Health AuthorityFred Martin (Moving Forward Co-Chair), West Prince Pharmacy Zubin Austin, Association of Faculties of Pharmacy of CanadaPatty Brady, Human Resources and Social Development CanadaJanet Cooper, Canadian Pharmacists AssociationTim Fleming, Canadian Association of Pharmacy TechniciansDennis Gorecki, Association of Deans of Pharmacy of CanadaRay Joubert, National Association of Pharmacy Regulatory AuthoritiesPaul Kuras, Canadian Pharmacists AssociationAllan Malek, Canadian Association of Chain Drug StoresLinda Suveges, The Pharmacy Examining Board of CanadaKen Wou, Canadian Society of Hospital Pharmacists

National Advisory CommitteeSandra Aylward, Sobeys Pharmacy GroupDanuta Bertram, Winnipeg Regional Health AuthorityPaul Blanchard, New Brunswick Pharmacists AssociationAnne Marie Burns, Ottawa HospitalLynda Buske, Canadian Medical AssociationJean-François Bussières, Hôpital Sainte JustineNicolas Caprio, Shoppers Drug MartDeborah Cohen, Canadian Institute for Health InformationOmolayo Famuyide, Canadian Association of Pharmacy Students and InternsRock Folkman, Canadian Pharmacy Technician Educators AssociationAnne Marie Ford, Ford’s ApothecaryMichael Gaucher, Canadian Agency for Drugs and Technologies in HealthAline Johanns, New Brunswick Department of HealthNadine Lacasse, Sebastien Aubin et Nadine Lacasse PharmaciensManon Lambert, Ordre des pharmaciens du QuébecLisa Little, Canadian Nurses AssociationJonathan Mailman, Canadian Association of Pharmacy Students and InternsRon McKerrow, British Columbia Provincial Health Services AuthorityColleen Norris, Glebe Pharmasave

Acknowledgements


3

Acknowledgements

Bonnie Palmer, Shoppers Drug MartNoman Qureshi, International Pharmacy Graduate Alumni AssociationMichelle Rousel, New Brunswick Department of HealthChris Schillemore, Ontario College of PharmacistsBrenda Schuster, Regina Qu’Appelle Health RegionJane Wong, Canadian Healthcare Association

IPG Working Group and AdvisorsJosiah Akinde, International Pharmacy Graduate Mohja Alia, Metropolitan Immigrant Settlement Association Nicky Corkum, IWK Health CentreCatherine Ekeland, University of British ColumbiaBrian Hunjan, International Pharmacy GraduateSandi Hutty, University of British Columbia Wendy Lack, Shoppers Drug MartRuth MacKenzie, Yukon GovernmentAnik Minville, Ordre des pharmaciens du Québec Mustapha Olajuwon, International Pharmacy GraduateJohn Pugsley, The Pharmacy Examining Board of CanadaMyrella Roy, Canadian Society of Hospital PharmacistsShiva Justin Singh, International Pharmacy GraduateJulia Stanbridge, Bredin InstituteFarzhad Valankani, International Pharmacy GraduateCibele Walsh, International Pharmacy Graduate

Project StaffHeather Mohr, Project ManagerKelly Hogan, Research Coordinator

Acknowledgements


Acronyms Used in this Report

ACPE Accreditation Council for Pharmacy Education

CAP Comité d’admission à la pratique

CIC Citizenship and Immigration Canada

CIIP Canadian Immigration Integration Project

CP3 Canadian Pharmacy Practice Programme

CPhA Canadian Pharmacists Association

CPS Canadian Pharmacy Skills program

CSHP Canadian Society of Hospital Pharmacists

ELT Enhanced Language Training

IEHPI Internationally Educated Health Professionals Initiative

IELTS International English Language Testing System

IPG International Pharmacy Graduate

MISA Metropolitan Immigrant Settlement Association

NAPRA National Association of Pharmacy Regulatory Authorities

OCP Ontario College of Pharmacists

OSCE Objective Structured Clinical Examination

PEBC Pharmacy Examining Board of Canada

TOEFL Test of English as a Foreign Language

UBC University of British Columbia

U of T University of Toronto

Acronyms Used in this Report


5

Introduction

Background to the ProjectPharmacists are a major component of the Canadian health care system, making up thethird-largest segment of health care professionals in Canada.1 There are approximately30,250 licensed pharmacists in Canada.2 Three-quarters (75%) of practising pharmacistswork in community practice, 15% work in health care facilities (including hospitals andhealth clinics), and the remaining 10% work in universities, pharmaceutical companies,government departments, associations, and other organizations.3

While the Canadian faculties of pharmacy produce approximately 900 graduates eachyear,4 Canada’s pharmacist workforce draws heavily on individuals who were educatedoutside of Canada to meet pharmacy labour market demands. There is currently nocomprehensive source of data on the number or proportion of internationally trainedpharmacists in the Canadian pharmacy workforce. However, recent data from theCanadian Institute of Health Information report that the percentage of practising, licensedpharmacists who obtained their pharmacy education outside of Canada (or the UnitedStates of America) is 27% in Ontario and 8% in Alberta.5 While these statistics are not yetavailable for other provinces and territories, internationally trained pharmacists,commonly known as International Pharmacy Graduates (IPGs), represent a significantportion of the pharmacist workforce in Canada.

For the purposes of this study, IPGs are defined as individuals who completed theirundergraduate pharmacy education, or obtained their licence to practice, outside ofCanada or the United States of America. IPGs often face many challenges in integratingsuccessfully into Canadian pharmacy practice. Evidence suggests that these challengesinclude a lack of fluency in English or French, a lack of understanding of disease states ortreatments that they may not have encountered in their country of origin, and generaldifficulties in communicating with patients and other members of the health care team insettings where professional and cultural norms may be different from what they areaccustomed to. A lack of clinical applied knowledge and of practical experience have alsobeen noted as important challenge.6

Research suggests that Canada is experiencing a strong demand for pharmacists. Oneestimate suggests that there are vacancies for approximately 2000 pharmacists acrossCanada, with approximately half of these vacancies in Ontario. While anecdotal reportssuggest that the demand for pharmacists has decreased in recent years, many pharmacies,

Introduction

1. Poston, J. International Pharmacy Graduates: Briefing to the Standing Committee on Citizenship and Immigration.Canadian Pharmacists Association, March 10, 2005.

2. National Association of Pharmacy Regulatory Authorities. National Statistics. Available from:http://www.napra.org/docs/0/86/363.asp. Accessed September 19, 2007.

3. Poston, J. International Pharmacy Graduates: Briefing to the Standing Committee on Citizenship and Immigration.Canadian Pharmacists Association, March 10, 2005.

4. Austin, Z, Rocchi Dean, M. Bridging education for foreign-trained professionals: the International Pharmacy Graduate(IPG) Program in Canada. Teaching in Higher Education. Jan 2006;11(1):19-32.

5. Canadian Institute for Health Information, Pharmacist Database, 2006 data.6. Austin, Z, Rocchi Dean, M. Bridging education for foreign-trained professionals: the International Pharmacy Graduate

(IPG) Program in Canada. Teaching in Higher Education. Jan 2006;11(1):19-32.


particularly in smaller cities and towns outside of the major urban areas, struggle to filltheir vacant positions. Demand for pharmacists is strong for a number of reasons,including the high numbers of retiring pharmacists and the expansion of chain drug storesoffering extended hours of service.7 Furthermore, the demand for pharmacists is likely toremain strong in the future: the aging of he baby boomer generation, the introduction ofnew drug therapies, and the overall increased demand for health services are all likely toheighten the need for pharmacists.

This demand for pharmacists mirrors a nationwide shortage of health care workers.Shortages in health human resources are so prevalent that the federal government hasinitiated a Pan-Canadian Health Human Resources Strategy aimed at increasing therecruitment and retention of health professionals. An integral part of this strategy is theInternationally Educated Health Professionals Initiative (IEHPI), designed to reduce thebarriers to practice for internationally educated health professionals to enable them tosuccessfully integrate into the Canadian health workforce.

As Canadian health care evolves to support new roles and responsibilities for pharmacists,ensuring that IPGs are fully prepared for a career of pharmacy practice in Canada becomesmore critical.

Purpose and Scope of StudyAnecdotal evidence has long suggested IPGs face challenges to successful integration inthe Canadian pharmacy workforce. The results and findings of this study provide a body ofwork that will identify and describe the challenges faced by IPGs, and offer informationthat can be used to address these challenges.

Specifically, the research is intended to provides:• A comprehensive picture of IPGs in Canada, including their demographic profile,

countries of origin, and their employment status and goals;• An understanding of the information, supports, and programs that are available to

IPGs, and the perceived effectiveness of these resources;• An understanding of the challenges facing IPGs in obtaining their license to practice,

and practising, as pharmacists, and• An understanding of what additional supports could help IPGs to successfully

integrate into pharmacy practice.

This project resulted in three major deliverables:• This integrated research report, detailing the findings and conclusions from all

research activities;• A detailed inventory of the bridging programs and courses available to IPGs, and• A Road Map, detailing the steps IPGs take in the process of becoming licensed to

practice as pharmacists in Canada, and the resources available at each step.

Introduction



7

Overview of ReportThis report outlines the detailed results and key findings based on the available research.Following a short overview of the research approach and methodology, the report isstructured to follow the major stages in the process of integrating into the Canadianpharmacy workforce.

The first section of findings, Settling in Canada, provides a profile of IPGs settling inCanada, details the expectations of IPGs in coming to Canada, and discusses what sourcesof information they use when deciding to come to Canada.

Licensing and Registration presents findings related to the process of IPGs becominglicensed or registered to practice as pharmacists in Canada.

The third section, Bridging Programs, summarizes the programs available for IPGs,discusses their perceived effectiveness, and looks at gaps in supports for IPGs.

Finally, Working in Canada provides findings on the extent to which IPGs are findingemployment in Canada, on employer perceptions of working with IPGs, and on what ishelping or hindering the successful integration of IPGs into pharmacy practice.

The report then presents a summary of Key Findings based on the research.

The report also includes, as Appendices, a bibliography as well as data collectioninstruments for the project.

Introduction


Section 1: Research Approach and Methodology

Research DesignThe Integration of International Pharmacy Graduates into the Canadian PharmacyWorkforce: Barriers and Facilitators is a comprehensive study involving multiple researchcomponents. The study examines the issues facing IPGs from a variety of sources, andincludes both primary and secondary data.

The information in this report represents a synthesis of information obtained throughmixed-mode surveys of IPGs and pharmacy employers, interviews with key stakeholders,focus groups with IPGs and employers, as well as a literature and statistical review. Wherepossible, triangulation of sources is used to demonstrate the extent to which findings areconsistent or different across data sources.

Specific Research ComponentsSurveysSurvey of International Pharmacy Graduates Surveys were undertaken with IPGs from across Canada in order to gather data on theirexperiences since deciding to settle in Canada, and their perspectives on Canadian pharmacyworkforce integration. A total of 1067 IPGs completed survey questionnaires for the study.

IPGs were contacted about the survey using a variety of methods. Over 2100 postage-paidpostcards and survey information letters were mailed from the Pharmacy Examining Boardof Canada (PEBC) to international pharmacy graduates currently active within the PEBC


Province Number % of Total Surveys

Ontario 887 83%

Alberta 64 6%

British Columbia 45 4%

Quebec 43 4%

Manitoba 12 1%

Saskatchewan 6 1%

Nova Scotia 5 1%

New Brunswick 4 0.4%

Newfoundland and Labrador 1 0.1%

Prince Edward Island 0 0%

Territories 0 0%

Total 1,067 100%

Figure 1—1IPG Survey Respondents by Province


9

certification process. IPGs interested in participating in the survey were asked to providetheir name and contact information on the postcard provided and place it in the mail.These postcards were returned to the consultant, and IPGs who had responded werecontacted by telephone to participate in the study.

The study was also publicized by the Canadian Pharmacists Association (CPhA), theCanadian Society of Hospital Pharmacists (CSHP), the Canadian Association of Chain DrugStores (CACDS), and the provincial pharmacy regulatory authorities using email notices,posting of information about the survey on their websites, and advertisements innewsletters. As a result, many IPGs contacted the consultant directly in order toparticipate in the surveys and focus groups. Finally, the Ontario College of Pharmacists(OCP) provided the consultant with contact names of approximately 2700 provinciallylicensed IPGs in Ontario.

The survey questionnaire was available in English and French versions, and thequestionnaire underwent a plain language review prior to distribution.

All IPGs interested in participating in the study were given multiple methods ofcompleting the survey questionnaire. IPGs had the option of completing the survey bymail, fax, online, or over the telephone. In all 1067 surveys were completed.

Employer SurveySurveys were undertaken with pharmacy managers/owners, directors, and humanresources managers from across Canada. The survey addressed the extent to whichpharmacies have employed IPGs, and their perspectives on what challenges IPGs face.


Province Number % of Total Surveys

Ontario 106 34%

Alberta 44 14%

British Columbia 31 10%

Quebec 47 15%

Manitoba 18 6%

Saskatchewan 15 5%

Nova Scotia 12 4%

New Brunswick 12 4%

Newfoundland and Labrador 13 4%

Prince Edward Island 10 3%

Territories 7 2%

Total 315 100%

Figure 1—2Employer Survey Respondents by Province

In May 2007, 1014 survey packages containing a cover letter, frequently asked questions,and a copy of the survey were mailed out to a sample of pharmacy employers acrossCanada. The names and addresses of these employers were obtained from a mailing listprovided by Dendrite. Dendrite, (formerly Synavant), has compiled a list of all pharmacistsin Canada practicing in hospital or retail. This list was cross-referenced against a databaseobtained from CSHP and, where there were differences, the contact names and addressesof the CSHP database were used. As a result of the relatively low number of Quebechospital pharmacies in the Dendrite sample, additional hospital pharmacy directors fromQuebec were added, using the list provided by CSHP. As with the survey of IPGs,respondents had the option of completing the survey in French or English, and by mail,fax, online, or by telephone, and the surveys were publicized through CPhA, CSHP, CACDSand the provincial pharmacy regulatory authorities.

A total of 315 surveys were completed by employers. Among those respondents, 51% wereemployed in chain, banner or franchise drug stores, 29% in independent pharmacies, 19%in health care facilities, and 1% in other types of organizations.

Based on the overall population of 8053 pharmacies reported by the National Associationof Pharmacy Regulatory Authorities (NAPRA), the survey has a margin of error of ±5.4%,19 times out of 20.

Qualitative Research ComponentsKey Informant Interviews Semi-structured key informant interviews were undertaken with a wide range ofstakeholders involved in pharmacy across Canada. A total of 37 in-person and telephonekey informant interviews were conducted, with representatives from 10 bridging programs



Figure 1—3Percentages of Employer Survey Respondents by Type of Pharmacy

Source: Employer Survey Q9n=315

51%

19%29%

1% other

Independent pharmacy

Chain, banner or franchisedrug store

Health care facility

Source: Employment survey Q9n=315


11

and courses, and with 27 representatives from provincial pharmacy regulatory authorities,national and provincial pharmacy associations, large pharmacy chains, and settlement andsupport agencies. Questionnaires for these key informant interviews were developed bythe consultant, were reviewed by the working group, and contained both quantitative(close-ended) and qualitative (open-ended) questions looking at a variety of topics,including licensing, bridging programs and courses, and working in Canada.

Following the completion of interviews with the providers of bridging programs andcourses, nine fact sheets were developed that detailed bridging programs and courses,currently offered in Canada for IPGs.8 These fact sheets represent a current inventory ofbridging programs and courses available to IPGs in Canada. To ensure accuracy, these factsheets were verified by the program/service managers.

Focus groupsOnce preliminary analysis of the surveys and interviews had been conducted, six focus groupswere held with employers (two groups), and with IPGs (four groups), to further explore theresearch issues. Focus groups were conducted in Toronto, Montreal and Edmonton.

Participants were recruited from among those survey respondents who indicated aninterest in taking part in a focus group. To supplement this group, additional pharmaciesin Toronto and Edmonton were contacted to identify and invite further employer or IPGparticipants. Potential focus group participants were also identified through the project’sIPG Working Group and the project team’s Expert Advisor Marie Rocchi.

The Consultant recruited a mixture of participants for the focus groups. Eligible IPGparticipants included individuals who had completed their undergraduate pharmacyeducation outside of Canada and who were working as pharmacists in Canada, currentlypursuing licensure in Canada, or were no longer pursuing their licence. Eligibleemployers included managers and owners who had hired and/or who currently employedan IPG, as well as those who had not.

Literature and Statistical ReviewReports and academic literature of relevance to the study were reviewed to obtain anunderstanding of the issues surrounding the integration of IPGs into the Canadian pharmacyworkforce and in order to inform the development of survey instruments for this study. Alisting of the articles/publications reviewed as part of this study is provided in Appendix A.

In addition, the Consultant reviewed statistical data of relevance to the study. For example,data was obtained from Citizenship and Immigration Canada (CIC) on the number ofindividuals coming to Canada as permanent residents declaring their intention to work aspharmacists.

The Consultant also obtained detailed statistics from PEBC’s exam management systemdatabase on both the number of unique IPGs and domestic graduates attempting andsuccessfully completing the PEBC Document Evaluation and Evaluating and Qualifying


8. Although the Consultant conducted 10 interviews with bridging and support program providers, nine fact sheets wereprepared for programs specifically relevant to IPGs.


Examinations for the years 2002 to 2006. These statistics were obtained based on the finalattempt recorded by the PEBC of any IPG for each certification step; therefore eachattempt represents one unique individual. However, as statistics were not capturedbeyond 2006, it is expected that a certain number of IPGs who were unsuccessful at theirexam attempts may have gone on to make further attempts beyond the end of the datatracking period. This is especially true of those IPGs making their recorded attempts in thelater years of the studied time period. The number of IPGs who have indeed gone on tomake later attempts is not known.

In addition to statistics on individual IPG candidates, the PEBC also provided statisticsillustrating the “pass rates” of IPGs for each examination sitting. According to the PEBC,pass rate is calculated per exam sitting by dividing the total number of exams written persitting by the number of exams which were successfully passed. These statistics do notdistinguish between individual IPGs over sittings, and care must be taken when usingthese statistics to illustrate performance by pass rates over multiple years.

Research ConsiderationsThe Integration of International Pharmacy Graduates into the Canadian PharmacyWorkforce: Barriers and Facilitators used a variety of data sources and types ofinformation in order to assure that its findings were based on defensible andcomprehensive information. However, some limitations of the research should be noted.

A large proportion of IPGs were identified through the PEBC and the provincial pharmacyregulatory authorities. As a result, most IPGs surveyed for the project had either attemptedto obtain certification for licensure through the PEBC or were licensed to practise as apharmacist. While some IPGs were informed through word of mouth and throughreferrals from settlement services and other venues, those IPGs in Canada who have notattempted to become licensed as pharmacists are likely under-represented in the surveyresponses. The extent to which the survey respondents are representative of all IPGs inCanada is not known.

While the surveys were publicized across Canada through the national and provincialpharmacy associations and the provincial pharmacy regulatory authorities, the ability toundertake a direct mail-out of the surveys to IPGs licensed through OCP and the inabilityto do so in other provinces has likely resulted in IPGs in Ontario being over-representedamong survey respondents. Further, those IPGs in Quebec, where pharmacists are notrequired to be certified to practice through the PEBC, are likely somewhat under-represented.

Only a small number (1%) of American-educated IPGs responded to this survey. Thispercentage should not be seen as necessarily representative of the number of American-educated pharmacists in Canada. While the definition of IPG used for this study wasinclusive of American-educated pharmacy graduates, the study was not marketed to thisgroup. Similarly, IPGs from the United States are exempt from the Evaluating Exam and, assuch, they are not included in the PEBC statistics on these examinations displayed in thereport.

Finally, findings from the six focus groups represent the views of a limited number of IPGsand employers. While illuminating, the views of focus group participants should not beseen as necessarily representative of all IPGs and employers.



13

Section 2: Findings

Settling in CanadaProfile of IPGs Settling in CanadaIn 2006, 426 permanent resident immigrants came to Canada with the declared intentionof working as a pharmacist.9 This figure includes only those immigrants coming to Canadaunder the economic class and excludes those coming under family class (including beingsponsored by a family member) who are not required by CIC to declare their intendedoccupation.10 This number also does not include temporary workers or those economicclass immigrants intending to work as pharmacy technicians or assistants.

The majority (60%) of these individuals were destined for Ontario, with British Columbia(15%) and Quebec (14%) being the next two most common provinces of destination in2006. Over the period 1996 to 2006, British Columbia, Quebec and Alberta alternate asthe second and third most popular destination provinces. The number of permanentresident immigrants with the intention to work as pharmacists showed overall growth inthe years from 1996 to 2006.

Section 2: Findings

Province/Territory of Destination 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Newfoundland and Labrador — — — — — — — 0 0 — —

Prince Edward Island 0 0 0 0 0 0 0 — 0 0 —Nova Scotia 5 9 — — — — — — — — —New Brunswick 0 0 — 0 — — — 0 0 — —

Quebec 19 16 17 14 16 21 41 66 77 67 58

Ontario 220 260 197 204 314 340 421 313 310 364 257Manitoba 6 9 5 6 10 5 6 8 — 10 —Saskatchewan — — — — — 0 — 0 0 — —

Alberta 14 14 21 15 16 17 22 14 33 31 36British Columbia 47 52 41 38 43 60 52 45 56 68 63Yukon — 0 0 0 0 0 0 0 0 — 0Province or territory not stated 0 0 0 0 0 0 0 0 0 0 0

Total 316 364 291 281 405 452 548 451 489 534 426

Figure 2—1Number and Province/Territory of Immigrants to Canada — Permanent Residents,Economic Class, with Intention to Work As Pharmacists in Canada (1996-2006)

Source: Citizenship and Immigration Canada, Facts & Figures 2006.Note: Due to privacy considerations, some cells have been suppressed and replaced with the notation "—". As a result, components may not sum to the total indicated. In general, suppressed cells contain less than five cases.

9. This number represents those indicating to CIC that they intended to work as pharmacists after immigrating; the extent to which this reflects their actual goals is not known.

10. According to CIC, 55% of immigrants to Canada fall under economic class status, compared to 28% under family class.The remainder (17%) includes refugees or others.

According to the survey of IPGs undertaken for this study, IPGs immigrating to Canadacommonly received their undergraduate pharmacy education in Southeast Asia (30%) orthe Middle East (26%). Other common areas of education were Europe (excluding theUnited Kingdom) (12%), Africa (11%), and the United Kingdom (11%).

While most IPGs come to Canada with undergraduate degrees, a significant proportion of IPGs also have postgraduate pharmacy degrees. 14% of surveyed IPGs indicated thatthey had completed a master’s degree, 8% had completed a PharmD degree, and 3% had completed a PhD. It is not known if these reported graduate degrees were entry-to-practice requirements in the IPG’s country of origin.

Generally, IPGs appear to have experience working as pharmacists in their countries oforigin. The majority (85%) of surveyed IPGs indicated that they had practised aspharmacists before settling in Canada. About one-half (49%) of IPGs had primarilypractised as pharmacists in community pharmacies, while 18% had practised in thepharmaceutical industry, and 16% had practised in a hospital. Eleven per cent of IPGs hadexperience in more than one area of practise before coming to Canada. The remainderindicated that they had primarily practised in government, academic institutions, themilitary, or in fields of practice.


Section 2: Findings

11. Although a small portion of American graduates responded to the IPG survey, they were not part of the target sample.This percentage is not intended to reflect the percentage of American pharmacy graduates in the Canadian pharmacyworkforce.

Area %

Southeast Asia (e.g., the Philippines, India, Pakistan, Bangladesh) 30%

Middle East (e.g., Egypt, Israel, Iran) 26%

Europe (Not including the UK) 12%

Africa 11%

United Kingdom 11%

Other Asia (e.g., Japan, Korea) 3%

China 2%

Russia and Commonwealth of Independent States 2%

United States of America11 1%

Australia 1%

Caribbean (e.g., Trinidad and Tobago, Jamaica, West Indies) 1%

South America 1%

Figure 2—2Areas of the World Where IPGs Completed their Undergraduate Pharmacy Education

n=1,067Source: IPG Survey Q2As a result of multiple responses, totals may add up to more than 100%


15

The PEBC Evaluating Examination is a necessary step in the process of licensure for allprovinces except Quebec, and the available statistics on its candidates provide a profile ofmany IPGs in Canada. In 2006, one-half (50%) of IPG PEBC Evaluating Exam candidateswere 31 to 40 years of age. Those 20 to 30 years of age were the second most commongroup (26%), followed by those 41 to 50 years of age (20%).

IPGs attempting the Evaluating Exam were almost evenly split between men and women,with 52% of candidates being female and 48% being male.

Section 2: Findings

Primary Area of Practice %

Community 49%

Pharmaceutical industry 18%

Hospital 16%

Multiple areas of practice 11%

Government 3%

Academic institution 3%

Military 1%

Other 1%

Figure 2—3Primary Area of Practice of IPGs Before Settling in Canada

n=902Source: IPG Survey Q4b.

Figure 2—4IPG Evaluating Exam Candidates by Age (2006)

Source: PEBC Exam Management System Database

50%

26%

20%

4%

20-30

31-40

41-50

51-60


Deciding to Settle in CanadaDecisions on where to initially settle in Canada are being made by IPGs based on anumber of factors. IPGs in the focus groups in Toronto and Edmonton stated thatdecisions were based on where family and friends were located, and on their perceptionof where job opportunities may be. In many cases, the fact that friends and family fromtheir countries of origin were already residing in a particular city was felt to makeintegration into that community easier. In other cases, IPGs settled in communities wherethey already had opportunities to work, or where their spouses had found a job.

For the majority of the focus group participants in Montreal, fluency in the French languagewas the major deciding factor in their decision to settle in the province of Quebec. Asfrancophones, they felt it was logical to settle in Montreal. As one IPG stated, “On se réalisemieux dans un endroit où on peut communiquer aver les gens” [you can better reach yourpotential in a place where you can communicate with others]. Not only did IPGs in Montrealfeel that their ability to communicate in French would help their own personal andprofessional integration, but that it would ease the integration of their spouses and children.

Many IPGs felt that settling in a large city was a natural choice. One IPG stated that they feltthat bigger cities would have more employment opportunities for them. Another stated that,as a member of an ethnic community, it is easier to find acceptance in a big city.

Expectations of IPGs in Settling in CanadaOver three-quarters (78%) of IPG survey respondents indicated that, when they firstsettled in Canada, they expected that they would, at some point, work as a pharmacist.The majority of IPGs in the focus groups in Edmonton and Toronto had planned to workas pharmacists, or, as a second-best option, as pharmacy technicians. A few participantshad no specific expectations related to their own employment, as they were moving as aresult of their spouse’s employment opportunities or plans. IPGs in the focus group inMontreal had somewhat different expectations than those in the focus groups in Ontarioand Alberta; they generally did not expect to work as pharmacists immediately aftersettling in Canada. Many had been told that they would have to return to university inorder to obtain equivalency with Quebec pharmacists.

Sources of InformationIPG respondents consult a variety of sources of information to help them make theirdecision to practice as a licensed/registered pharmacist in Canada. IPGs most commonlyconsult the PEBC (73%), friends or peers living in Canada (67%), provincial pharmacyregulatory authorities (55%), or family living in Canada (48%).

The three most common sources of information that IPGs found effective or very effective werethe PEBC (44%), friends or peer living in Canada (43%), and the provincial pharmacy regulatoryauthority (30%).12 Of those IPGs who indicated another type of information consulted, moststated they consulted the Internet (no particular site specified) or Canadian universities.

IPGs in the focus groups identified the Internet as the most frequently used, and mostuseful, source of information for the purposes of deciding to settle in Canada. Like theIPG survey respondents, IPG focus group participants got information through the PEBCwebsite, which was said to be useful. Others noted that they had also found usefulinformation through the provincial pharmacy regulatory authorities’ websites.

Section 2: Findings

12. Percentages were calculated excluding “Don’t know” responses.


17

Information Lacking in the Country of OriginMany IPGs feel they did not have all the information they would have liked before settling inCanada. IPGs in the focus groups noted several information gaps, including the following:• A comprehensive, step-by-step overview of the process of becoming a pharmacist in

Canada, including what can be done to begin this process prior to coming to Canada.Some IPGs noted that they were not clear what documentation from their country oforigin would be needed in Canada, and that this caused difficulties or delays later inobtaining university transcripts and other documents.

• Methods of connecting with other IPGs (such as through an online chat room orother web-based forum). This was felt to be critical in order to create realisticexpectations of the licensing process.

• More information pertaining to the costs involved in licensure, the actual length oftime required to become licensed, the degree of difficulty of the process, and detailson particular requirements in different provinces.

Section 2: Findings

% IPGs WhoConsulted

Effectiveness of Source (according to IPGs)

Not Very Effective /SomewhatEffective

Effective /Very

Effective

Don’tKnow

Pharmacy Examining Board of Canada(PEBC) 73% 32% 60% 8%

Friends or peers living in Canada 67% 28% 64% 9%

Provincial pharmacy regulatory authority 55% 32% 54% 54%

Family living in Canada 48% 31% 48% 20%

Pharmacy employer 41% 36% 43% 21%

Friends or peers living outside of Canada 41% 52% 30% 19%

Canadian embassy or consulate 39% 56% 26% 17%

Federal government of Canada 37% 52% 25% 23%

Family living outside of Canada 34% 43% 31% 26%

Pharmacy recruiter 31% 37% 30% 32%

Canadian Pharmacists Association (CPhA) 28% 44% 24% 32%

Provincial government of Canada 26% 50% 19% 31%

Other (e.g., Internet, Canadian Universities) 97% 3% 9% 88%

Figure 2—5Usage and Effectiveness of Available Sources of Information in Helping IPGsMake their Decision to Practice as a Licensed/Registered Pharmacist in Canada

n=1067Source: IPG Survey Q6.


One key informant noted that the federal government has recently supported theprovision of more comprehensive information at the country of origin through theCanadian Immigration Integration Project (CIIP). This federal program, managed through the Association of Canadian Community Colleges, has provided workshops andone-on-one counselling sessions in countries of origin for those coming to Canadathrough the federal Skilled Worker Program to help to create realistic expectations of theprocess of personal and professional integration in Canada. According to the project’swebsite, the CIIP is operated in sites in Guangzhou, China; New Delhi, India; and Manila,the Philippines.13

Licensing and RegistrationIn order to practise as a pharmacist, IPGs must become licensed (or registered, as theprocess is known in some provinces) to practise by the pharmacy regulatory body of theirprovince.14 In all provinces except Quebec, the process of licensure for IPGs involves thefollowing activities (the order of which can vary by province):• Successful completion of the PEBC Document Evaluation process, which verifies

that the applicant has acquired a legitimate university degree from a program that isacceptable to PEBC, and includes a verification of the identity of the applicant;

• Successful completion of the PEBC Evaluating Examination, which demonstratescomparability of academic preparation in pharmacy;

• Demonstration of sufficient levels of English or French language fluency as definedby standardized tests such as the Test of English as a Foreign Language (TOEFL) orothers;

• Successful completion of an in-service apprenticeship period, known as structuredpractical training, under the supervision of a qualified pharmacist;

• Successful completion of the PEBC Qualifying Examination Part I, which involves awritten test of clinical knowledge;

• Successful completion of the PEBC Qualifying Examination Part II, the ObjectiveStructured Clinical Examination (OSCE). The OSCE (introduced in 2001) involvescandidates undertaking 16 seven-minute simulated patient interviews, or non-interactive stations, in order to test communication skills, clinical judgement and problem solving and ethical decision making, and

• Successful completion of a provincial examination related to pharmacy jurisprudence.

Domestic pharmacy graduates are also required to complete a structured practical trainingperiod, the PEBC Qualifying Examination Parts I and II, and a provincial jurisprudenceexamination. Graduates of American pharmacy programs are exempted from undergoingthe PEBC Evaluating Examination.

The PEBC is the certification body for the pharmacy profession in all provinces exceptQuebec, and is responsible for the assessment of graduates on behalf of participatingprovincial pharmacy regulatory authorities. Candidates (both IPGs and domesticgraduates) can make three attempts at the PEBC examinations, and the Board willconsider a request to attempt examinations a fourth time if the candidates are able to present acceptable evidence of continuing education units, course work (for theQualifying Exam Part I) or practical experience in pharmacy (for the Qualifying Exam

Section 2: Findings

13. Canadian Immigration Integration Project. Available from: http://ciip.accc.ca/default.aspx?DN=782,32,Documents. Accessed September 29, 2007.

14. In the territories, pharmacy practice is regulated through the cooperation of provincial regulatory bodies.


19

Part II). If candidates are unsuccessful in their fourth attempt, the PEBC Board does notpermit any additional attempts and the candidate cannot proceed further in the PEBCcertification process.

The licensing process for IPGs15 in Quebec is significantly different than in otherprovinces. In Quebec, academic qualifications are assessed on a case-by-case basis by apractice admissions committee (Comité d’admission à la pratique [CAP]) of the Ordre despharmaciens du Québec. On the basis of the CAP assessment, IPGs are required tocomplete university pharmacy courses in Quebec at one of the province’s two universitypharmacy faculties, University of Montreal or Laval University in order to be consideredequivalent in their education to Quebec pharmacy graduates. The licensure processrequires the successful completion of these courses as well as demonstration of Frenchlanguage fluency and the completion of the required number of structured practicaltraining (600 hours).

The pharmacy regulatory authority in Ontario also requires the completion of an IPGbridging program (available through U of T) as a requirement for licensure. It is currentlythe only province to include this requirement in addition to PEBC certification. This will bediscussed in greater detail in the section discussing pharmacy bridging programs for IPGs.

Information About the Licensure ProcessIPGs generally become informed about the various steps in the licensure process throughthe Internet and/or through the PEBC. Additionally, some areas of the country havedeveloped specific resources to help IPGs to understand and manoeuvre through thelicensing and registration process. For example, the Ontario College of Pharmacists (OCP)and the province of Ontario host a website designed for new pharmacists(www.newontariopharmacist.com). The site provides relevant information on thelicensing process in that province, including a fact sheet and frequently asked questionssection. In Nova Scotia, the Metropolitan Immigrant Settlement Association (MISA)produces a “welcome package” for new IPGs that provides step-by-step information on thelicensing process in that province.

Number of IPGs Seeking Licensure In 2006, 801 IPGs (excluding US graduates) successfully completed the PEBC DocumentEvaluation, the first step in the licensing process in all provinces except Quebec.16 As seenin Figure 2-6, among those IPGs successful in their Document Evaluation, most were fromSoutheast Asia (43%) (most commonly India, the Philippines, Pakistan), or the Middle East(30%) (most commonly Egypt, Iran, Jordan).

The number of IPGs undertaking each of the steps of the PEBC certification from 2002 to 2006is shown in Figure 2-7. Variations in annual totals of individuals attempting exams is likely dueto several factors, including difficulties on the part of IPGs in immigration procedures,immigration fluctuations due to external factors, or IPGs choosing careers not requiring apharmacy license. In particular, it should be noted that the Qualifying Examination Part II didnot exist prior to 2001, thus affecting the number of individuals attempting this exam for thefirst time.

Section 2: Findings

15. Including those trained in the United States of America16. The number of candidates who are not successful in their Document Evaluation is not recorded by PEBC, but PEBC

reports that this number is small.

An annual average of thenumber of unique IPGsattempting each stepduring the time periodstudied is also provided.Annually, an average of876 unique IPGs submitdocuments for Evalua -tion, 694 unique IPGsattempt the EvaluatingExamination, 524 uniqueIPGs attempt theQualifying Examin ationPart I and 433 attemptthe QualifyingExamination Part II.

The majority of IPG survey respondents (72%) indicated that they had their licence/registration to practise as a pharmacist in a Canadian province. Licensed IPGs in the surveyindicated a wide range of estimated amounts of time required for them to complete thelicensing/registration process. As shown in Figure 2-8, while about one-quarter (24%) of IPGscompleted their licensure in one year or less, 58% required two years or more. The averageamount of time to complete licensure was 26 months, and the median time was 24 months. (Theaverage length of time did not vary significantly when analyzing responses from IPGs in differentareas of the country, although the number of responses was limited from many provinces.)

Year 2002 2003 2004 2005 2006 Total (2002–06)

Annual Average

Submitting Documents Evaluation 994 783 952 854 801 4,384 876

Attempting Evaluating Exam 531 657 787 753 754 3,482 694

Attempting Qualifying Exam Part I 323 449 518 626 704 2,620 524

Attempting Qualifying Exam Part II 254 382 446 459 626 2,167 433

Figure 2—7Number of Unique IPG Attempting Each of the PEBC Certification Steps (2002-2006)

Source: Pharmacy Examining Board of Canada“Unique IPGs” refers to the number of single individuals attempting any of the PEBC examination or document evaluationprocess. Numbers of unique IPGs are obtained by tracking only the final attempt made by an IPG on any exam, whether it bepass or fail, during the years 2002 to 2006. Final attempt includes both the single, non repeated attempts of each unique indi-vidual, as well as the final attempt of multiple attempts by each unique individual, whether it be that individuals 2nd, 3rd or4th attempt) Any attempts beyond 2006 are not captured, therefore there is likely a certain number of IPGs who have gone onto make a later attempt at any of the examinations post 2006 and are therefore captured in the wrong category in this table.

Section 2: Findings


Area # %

Southeast Asia (e.g., the Phillippines,India, Pakistan, Bangladesh) 348 43.4%

Middle East (e.g., Egypt, Israel, Iran) 244 30.5%

Europe (Not including the UK) 27 3.3%

Africa 70 8.7%

United Kingdom 21 2.6%

Other Asia (e.g., Japan, Korea etc.) 27 3.4%

China/Taiwan 22 2.7%

Commonwealth of Independent States 20 2.5%

Australia/New Zealand 3 0.4%

Caribbean/Central America 11 1.4%

South America 8 1.0%

Total 801 100%

Figure 2—6Countries of Origin of IPGs Successfully Completing PEBC Document Evaluation (2006)

Source: Pharmacy Examining Board of Canada

Performance of IPGs inthe PEBC NationalPharmacy ExaminationsFigure 2-9 presents thepass rates of IPGs for allexamination sittingsbetween 2002 and 2006,for each of the threePEBC examinations. Asdemonstrated, pass ratesare somewhat higher for

the Evaluating Examination than for either of the two parts of the Qualifying Examination.Pass rates are calculated based on number exams written at each exam sitting divided bythe number of exams which are passed at that sitting. These statistics do not distinguishbetween individual IPGs over sittings, and care must be taken when using these statisticsto illustrate performance by pass rates over multiple years.

Number of Attempts at PEBC ExaminationsAs shown in Figure 2-10, during the period from 2002 to 2006, 74% of unique IPGs attemptingthe Evaluating Examination did so only once. Of these single attempters, 61% of those uniqueIPGs passed the exam on their first attempt. 26% of unique IPGs attempting the EvaluatingExamination in that same time period did so multiple times. The remainder (13%) failed ontheir first attempt and did not repeat the exam during the time period studied. Some of theseindividuals may in fact go on to repeat the exam after 2007 and are not captured in the data. Inaddition, the PEBC also reports that IPGs may occasionally not repeat the exam due to failure toobtain the necessary visa to return to Canada for the exam (or other immigration proceduraldelays), or the IPG simply choosing another career that does not require a pharmacy license.17

By comparison, a much lower percentage of unique IPGs make only one attempt at thetwo parts of the Qualifying Examination. During the period of 2002 to 2006, 53% ofunique IPGS attempting the Qualifying Examination Part I did so only once. Of thesesingle attempters, 43% passed on their first attempt. However, a full 46% of unique IPGsattempting the Qualifying Examination Part I in that same time period did so multiple

Section 2: Findings


21

Estimated Lenth of Time %

1 year or less 24%

More than 1 year to less than 2 years 19%

2 years or more 58%

Figure 2—8Estimated Length of Time of Licensing/RegistrationProcess for IPGs

n=750Source: IPG Survey Q8c

17. Dr. John Pugsley, Pharmacy Examining Board of Canada.

Pass Rates AmongIPGs Making their

First Attempts

Pass Rates AmongIPG Exam Repeaters

Pass Rates AmongIPGs at All Sittings

Evaluating Exmaination 61% 54% 59%

Qualifying Exam Part I 44% 55% 49%

Qualifying Exam Part II 39% 54% 45%

Figure 2—9Observed Pass Rates of IPGs in the PEBC Examinations (Total 2002-2006),First Attempts, Repeaters, and Total

Source: Pharmacy Examining Board of Canada.*Pass Rate for IPGs is calculated for each individual exam sitting, and represents the number of exams successfully passedby IPGs divided by the number of exams written.

times. The remainder (10%) failed on their first attempt at the Qualifying Examination PartI and did not go on to repeat it during the time period studied. It is expected that acertain percentage of this remainder have attempted (or will attempt) Part I of the examduring 2007 or beyond.

For the Qualifying Examination Part II, 51% of unique IPGs attempting this exam did soonly once. Of these single attempters, 39% passed the Qualifying Examination Part II ontheir first attempt. A large 48% of unique IPGS attempting the Qualifying Examination PartII go on to make multiple attempts at this exam. The remainder (12%) failed on their firstattempt and did not go on to repeat the exam during the time period studied. Similar toabove, it is expected that a certain percentage of this remainder have attempted (or willattempt) Part II of the exam during 2007 or beyond.

As a point of comparison, almost all domestic graduates took just one attempt at the QualifyingExamination Part I (94%) and the Qualifying Examination Part II (96%) during that period.

Challenges Faced by IPGs in the Licensing and Registration ProcessIPGs felt that the PEBC Qualifying Examination, particularly the OSCE, was the most difficultpart of the licensing process. About three-quarters of surveyed IPGs felt that the QualifyingExamination Part I (74%) and Qualifying Examination Part II (77%) were “difficult” or “verydifficult”, with 19% rating Qualifying Examination Part I and 28% rating QualifyingExamination Part II as “very difficult”, respectively. The Evaluating Examination was also ratedas “difficult” or “very difficult” by a majority (58%) of IPGs. Finding a practical trainingposition was rated as “very difficult” by 26% of IPGs, and “difficult” by 28% of IPGs.

In addition to the difficulties experienced with the examinations and the structuredpractical training, the time required to complete the licensing process was felt to be achallenge. IPGs often struggle with multiple demands on their time, including, in manycases, the demands of work, family, and preparing for exams. This can be especiallydifficult for recent immigrants, who may not have a strong support network in their newcommunity, and who are adjusting to living in a new culture. One IPG focus groupparticipant explained that s/he was working, studying for the PEBC exams, and lookingafter two small children while her/his spouse worked full-time.

Section 2: Findings


% of Unique IPGsPassing on

First Attempt (During 2002–2006)

% of Unique IPGs Failing on

First Attempt and Not Repeating

(During 2002–2006)

% of Unique IPGs Making

Multiple Attempts (During 2002–2006)

Evaluating Examination 61% 13% 26%

Qualifying Exam Part I 43% 10% 46%

Qualifying Exam Part II 39% 12% 48%

Figure 2—10Percentages of Unique IPGs who Make Single Attempts (Successful and Unsuccessful) and Repeated Attempts at the PEBC Examinations (Total 2002-2006)

Source: Pharmacy Examining Board of CanadaNumber of Unique IPGs is calculated based on the final attempt the IPG makes on a given exam. Attempts made beyond2006 are not captured, therefore it is expected that a certain number of IPGs under the “% of Unique IPGs Failing on FirstAttempt and Not Repeating (During 2002-2006)” do in fact go on to attempt the exam in later years.

The cost of examinations was also a barrier noted by focus group IPGs. The cost of theDocument Evaluation in 2007 was $475, the Evaluating Examination was $460, theQualifying Examination Part I is $300 and the Qualifying Examination Part II is $1,350.This brings a total cost of $2,220, providing the candidate passes each step. Failedexaminations must be retaken and fees paid again for each examination. For many, thesecosts are high, particularly if they are in addition to the costs of taking required bridgingor university programs. As one IPG in the focus groups said, “If my husband didn’t work, I wouldn’t be able to pay for the exams.” Others commented on the fact that they wereunable to obtain loans or grants to help to cover the costs of licensure. Key informantsfrom the provincial pharmacy regulatory authorities and provincial pharmacy associationsalso noted that high costs are a challenge for IPGs, especially those with families who haverecently immigrated to Canada.

Furthermore, IPGs often struggle to find the information they need on the licensureprocess and on how to find studentship, internship, or volunteer positions. Some IPGsfeel they are not sufficiently prepared for the exams prior to their exam attempts.

Key informants from provincial regulatory authorities, provincial pharmacy associationsand pharmacy chains also highlighted the following barriers or challenges for IPGs ingetting licensed or registered:• Difficulty finding practice sites for studentship/internship: IPGs are

responsible for finding their own placements at pharmacies to complete theirstudentship/internship. Key informants indicated that it was difficult for IPGs to findthese spots/placements. This was felt to be at least partly the result of the perception

Section 2: Findings


23

Very Easy Easy Difficult Very Difficult

PEBC Qualifying Exam Part II (ObjectiveStructured Clinical Examination) 3% 21% 49% 28%

PEBC Qualifying Exam Part I (Multiple Choice Questionnaire) 1% 25% 55% 19%

PEBC Evaluating Exam 5% 37% 43% 15%

Finding a practical training position 13% 33% 28% 26%

Getting licensed/registered in yourprovince 8% 45% 35% 12%

Meeting other educational requirementsin your province (e.g., Ontario IPG program requirements, Quebec diplomaequivalency education, etc.)

9% 48% 30% 13%

Meeting English or French fluency requirements 21% 42% 26% 10%

Having documents examined by PEBC 17% 57% 20% 6%

Provincial jurisprudence examination 23% 65% 11% 1%

Figure 2—11Perceived Difficulty of Each Step in the Licensing/Registration Process

Source: IPG Survey Q11n=1,067Percentages were calculated excluding “don’t know” responses.

Section 2: Findings


that taking on an IPG for a studentship/internship would involve a lot of effort on thepart of the employer or preceptor.

• The process of licensure is time-consuming: The process for obtaining a licencecan be time-consuming, particularly if IPGs fail an exam and have to wait six monthsfor the next session in order to re-sit the exam.

• Language barriers can complicate the process of finding information about thelicensing process, and make the process of getting licensed very difficult. Languagebarriers can include not just knowledge of standard English, but also awareness ofCanadian idioms, expressions and health care workforce terminology.

• Cultural differences related to pharmacy practice: IPGs often arrive in Canadafrom areas of the world where pharmacy practice is very different, sometimesrequiring less direct patient care. An understanding of the Canadian model of practiceis necessary to successfully complete the licensure process.

• A shortage of places in pharmacy university courses in Quebec was felt to be abarrier to licensure/registration. IPGs wishing to practise in Quebec must attend universitycourses at one of Quebec’s two faculties of pharmacy, but spaces are limited.18

Additional Programs or Services Needed to Support IPGs on the Path to LicensureSurveyed IPGs feel that more support is needed for them on the path to licensure. Amongall surveyed IPGs, 48% said they felt there was a need for additional bridging programs orother mechanisms to support IPGs while they are becoming licensed/registered asCanadian pharmacists. Only 26% said they did not feel more was needed and 25% saidthey did not know or were unsure. While regional comparisons should be viewed withcaution due to the small number of IPG respondents outside of Ontario, the proportion ofIPGs saying more programs or supports were needed was higher in Quebec and inwestern provinces than in Ontario.

Those IPGs who felt that additional supports were needed were asked to provide theirsuggestions on what specific types of supports or programs were needed. Responses tothis open-ended question were then coded. The results show that 28% said that morepractical opportunities were needed. In addition, 15% noted that less expensivealternatives to existing bridging programs and courses were needed, 15% said thatrefresher courses to help prepare for examinations were needed; and 15% said that theyfeel language training was needed.

In the focus groups, IPGs indicated that a significant challenge in the licensing process was alack of one comprehensive source of information to explain the process of getting licensed.While many IPGs felt that a lot of information was available through sources like the PEBCwebsite, it was also noted that they lacked access to an easy-to-understand source that clearlyoutlined all the steps in the process of integrating into the Canadian pharmacy workforce.

Many focus group respondents also noted that they felt somewhat isolated throughout theprocess of licensure, and would have liked to have been able to connect with others whowere either in the process of licensure, or who were licensed to practice. Some focusgroup participants felt that there was a need for an online chat room or some other typeof online forum for internationally educated health workers in Canada, or, better still,specifically for IPGs.

18. According to faculty websites, availability may be restricted depending on the number of Quebec applicants or reserved for international students from developing countries.

Section 2: Findings


25

Most employers (48%) also reported that there is a need for additional programs/servicesdesigned to support IPGs while they are on the path to licensure/registration as Canadianpharmacists (16% of employers reported that they do not feel that there is a need foradditional programs/services to support IPGs and 36% of employers indicated that theydid not know).

Those employers who felt that additional supports were needed were asked to providetheir suggestions on what specific types of supports or programs were needed. Responsesto this open-ended question were then coded. Most employers (48%) reported thatadditional “language/communication skills training” program/services are needed. At 19%,“more practical/clinical training” was the second most common response, followed by“cultural integration courses/programs to help with understanding of the Canadian healthcare system” (18%).

Figure 2—12Additional Program/Services that IPGs Feel Are Needed to Support Them onthe Path to Licensure/Registration*

n=469Source: IPG Survey Q13b*As a result of multiple responses, totals may add up to more than 100%.

Programs and supports that provide opportunitiesto gain practical work experience

Less expensive alternatives to existing bridging support programs/financial support

Refresher courses to help preapre for exams/preparation courses

Language training

Training on how to deal with cultural differences

Additional bridging and support programs offered in diffierent cities

More flexible/part-time bridging and support programs

University-based programs

A support system designed to give IPGs specific information on how to navigate the

Canadian pharmacy system

Other

0% 5% 10% 15% 20% 25% 30%

28%

15%

15%

15%

13%

6%

5%

4%

2%

8%

Supports Being Offered by EmployersAlthough the majority of employers (57%) reported that they do not offer any kind ofsupport specifically to IPGs (beyond general employment training or orientation), aportion of employers did indicate that they offer some type of support. Figure 2-13illustrates the proportion of employers offering different types of supports specifically forIPGs during the licensure process. Internships, student positions and mentoring were themost common responses, with 20%, 17% and 16% of employers respectively indicatingthey offered these supports.

Enablers of Success in the Licensing and Registration ProcessKey informants were asked what would help IPGs to overcome the barriers and challengesthat they face in the licensing and registration process. The bridging programs offeredthrough U of T and UBC were often identified as being excellent methods to overcome thechallenges of the licensure process, even though the overall goal of these programs is toprepare IPGs for a career of pharmacy practice. 65% of surveyed employers also felt thatbridging program were effective in assisting IPGs in becoming pharmacists in Canada.

However, bridging programs are not available in all provinces. There was felt to be a need forIPGs to access the same types of programs across Canada, rather than being confined to specificlocations. A bridging program was said to be in development in the province of Quebec, but

Section 2: Findings


Figure 2—13Supports Offered Specifically to IPGs by Employers

n=315Source: Employer Survey Q4As a result of multiple responses, totals may total more than 100%.

None

Internships

Student positions

Mentoring

Financial assistance with licensing/registration examinations

PEBC examination process preparation

Settlement assistance

Tuition support for bridging programs

Language training

Other

0% 10% 20% 30% 40% 50% 60%

57%

20%

17%

16%

7%

6%

6%

5%

4%

4%

Section 2: Findings


27

presently there was no bridging program available in that province. Furthermore, IPGs withoutfinancial assistance or help from employers may often lack the funds to pay for the costs ofthese programs, or the resettlement costs required to attend them.

In addition, both employers and key informants felt that mentorship was effective in helpingIPGs to overcome some barriers and challenges. In the survey of employers, 62% stated thatmentorship was effective in helping IPGs to become pharmacists in Canada. While somementorship has been available through the bridging programs, and other sources such asMISA in Nova Scotia, there was felt to be a need for more mentorship opportunities.

Key informants also felt that employers should be encouraged to take on IPGs whorequire practice sites for their internship/studentship. Similarly, most employers felt thatstructured practical training (69%) and practice opportunities provided by employers(64%) were effective in assisting IPGs in successfully obtaining their license andintegrating into practice.

Some IPGs in the focus groups found working as pharmacy technicians was helpful insofaras it allowed them to work in the field of pharmacy during the process of obtaining theirlicense to practice pharmacy, while still being able to earn the money they needed to helppay for the costs of licensure and the costs of living and having a family.

Finally, key informants often felt that there should be more information available to IPGsabout the steps involved in licensing/registration process.

Perceived Effectiveness of Licensing ProcessOver one-half of key informants from the provincial pharmacy regulatory authorities,provincial associations, and large pharmacy chains feel that the licensing process isappropriate and effective for IPGs, but a significant minority (a little less than half) did not.

Some key informants felt that the internship19 process and requirements for IPGs were notappropriate or effective in all provinces. The lack of consistency in the licensingrequirements between provinces was also felt to be an issue. Some felt that the number ofhours required for internship in Ontario is too long, especially in comparison to otherprovinces. Others noted that the requirement that IPGs undertake internship after theQualifying Examination (as is the case in Ontario) was not appropriate, and thatinternship can be useful to help IPGs prepare for the Qualifying Examination.

Another identified issue was the frequency of PEBC examinations. Eligibility for theQualifying Examination for IPGs is contingent on successful completion of the EvaluatingExamination. The Evaluating Examination, and the Qualifying Examination Part I and PartII are only offered twice per year and candidates who are not successful in examinationattempts at any phase must wait six months to retake that examination. As such, it wassuggested that examinations be offered more frequently.

Key informants also identified English (or French) language fluency as an issue that shouldbe addressed. For example, it was suggested that language fluency requirements shouldbe more stringent, and that sufficient language fluency should be mandatory at an earlystage in the licensing process.

19. In some provinces this is called a ‘studentship’.

Section 2: Findings


Key informants noted that the process by which IPGs’ foreign educational credentials areassessed in Quebec can be very time-consuming. IPGs are often required to take multipleclasses at one of Quebec’s two faculties of pharmacy in order to be deemed equivalent toQuebec graduates. This process was felt to be often quite lengthy, depending on when therequired classes are offered and the number of seats available.

Bridging ProgramsCurrent Bridging Programs Available for IPGsBridging programs are available to help IPGs become pharmacists in Canada. Bridgingprograms are formal, post-degree programs of study designed to address gaps between anIPG’s education or experience and standards of pharmacy practice in Canada. Bridgingprograms are not post-graduate degree programs, such as a PharmD or master’s program.Bridging programs are a relatively new phenomenon in Canada, with all of the bridgingprograms/courses identified in this report having existed for less than six years.

A number of bridging programs and courses are available for IPGs. Interviews withrepresentatives of nine of the 10 bridging programs identified in the research wereundertaken.20 According to interviewees, approximately 225 IPGs are currently enrolled ina bridging support program or course.

Figure 2-14 provides an overview of these programs. Currently, only the OCP has amandatory, although exemptible,21 requirement for completing a specific bridgingprogram as a condition of licensure.

20. Despite repeated attempts, one bridging/support program could not be reached for detailed information.21. Anyone who has graduated from a program accredited by the American Accreditation Council for Pharmacy Education

(ACPE) is exempt from the IPG program. This includes not only all American programs, but also the PharmD program atthe University of Lebanon. Similarly IPGs who successfully complete the PEBC Qualifying Exam Parts I and II may go toa panel of the registration committee and request an exemption from the IPG program.

Canadian Pharmacy Skills (CPS):University of Toronto (Toronto,Ontario)

The CPS program provides training for entry to practicecompetence.The program is offered full-time in two eightweek sessions. The program is offered in the spring and fall. The CPS program is a mandatory but exemptible requirement to become a licensed pharmacist in Ontario.

Enhanced Language Training(ELT) for Internationally Educated HealthProfessionals(IEHPs): Universityof Toronto (Toronto, Brampton,Scarborough, and Mississauga,Ontario)

The ELT program develops the language skills required tocommunicate within a health profession in Canada and tomeet the fluency requirements for licensing by the OntarioCollege of Pharmacists. This program runs three hours per week for fifteen weeks.

Figure 2—14Bridging Programs and Courses Available to IPGs in Canada

Section 2: Findings


29

Canadian Pharmacy Practice Programme (CP3): University of British Columbia(Vancouver, British Columbia)

The CP3 program is designed to allow internationallytrained pharmacists to achieve the competencies requiredfor practice in Canada. This is a live, 24 hours per week, 20 week program. Sessions are offered in the spring and thefall.The CP3 program is not a requirement to become a licensedpharmacist in British Columbia.

OSCE Preparatory Course: Agro Health Associates (Burlington, Ontario)

The purpose of this course is to develop communicationskills and instil the key competencies of pharmaceuticalcare to assist IPGs in preparing for the OSCE component ofthe licensing/registration process.It is a live, five-day, full-time (40 hours) program offeredtwice per year, immediately prior to the PEBC examinations.

International Pharmacy Bridging Program: Bredin Institute Centre for Learning (Edmonton and Calgary, Alberta)

The International Pharmacy Bridging program is designed to help IPGs develop and hone the professional knowledgeand skills necessary to acquire their license to practicepharmacy in Alberta. The program is a full-time, 41-week commitment that in-cludes the completion of 500 hours of structured practicaltraining. The program is offered twice per year and includesintensive OSCE preparation. The majority of students willreceive a 24-week grant to help cover expenses.Completion of this program is not required by the Alberta College of Pharmacists as a condition oflicensure/registration in Alberta.

Prescription for Learning: Communication Skills for the Practice of Pharmacy —Emerald Educational Services(Winnipeg, Manitoba and Edmonton, Alberta)

The program is designed to assist the integration of IPGsinto the Canadian workforce, either during their internshipphase of the licensing process or for those newly licensedIPGs who may benefit from participating in the course. Itcombines communication techniques and knowledge of theworkplace with topics and issues facing IPGs when workingin a Canadian pharmacy. The program is a 49-hour coursedelivered in-classroom setting over seven weekly seven-hoursessions. Program costs range from $350–$700 with possiblefunding opportunities from provincial governments.

Orientation to the CanadianHealth Care System: AssessmentCentre for Internationally Educated Nurses, ProfessionalDevelopment Centre (Halifax, Nova Scotia)

This program is designed to assist internationally educatedhealth care professionals in integrating and finding employment in Nova Scotia. The purpose of the program isto provide an overview of health care professions in Canadaand Nova Scotia.The program runs for 10 weeks with three-hour sessionsonce per week. It runs twice per year (spring/fall). The program is free of charge.

Figure 2—14 (continued)Bridging Programs and Courses Available to IPGs in Canada

The most extensive programs for IPGs are those offered through U of T (the CPS program)and UBC (the CP3 program). These programs consist of modules, some of which can betaken separately. Courses in the programs cover clinical skills and collaborative practice,with communication skills provided throughout the program.

In Ontario, OCP is examining whether or not the IPG program at U of T should beexemptible for IPGs. No other provincial regulatory authority indicated that they expectedchanges to the licensing/registration process in the near future.

No bridging programs currently exist in Quebec. According to key informants in thatprovince, a university-based bridging program for IPGs is currently under development.

Through a Health Canada grant, Austin and Rocchi are piloting an Orientation toCanadian Health Care Systems, Culture and Context course for internationally educatedhealth professionals that will be available on a pan-Canadian basis in various locations,and online.

In addition to the bridging programs offered through universities and private trainers, one chain drug store was said to be developing a bridging program for IPGs. Although theprogram was under development at the time of the research interview, the key informantfrom the chain described the program as involving a six-month program of classroom andpractical training, including a mock-OSCE component. According to the key informant,this program was being developed due to the difficulties that the chain was having inrecruiting domestically educated graduates for its pharmacies in small towns in moreremote locations of the country.

The cost of taking a bridging course or program varies depending on the length and/ortype of course. The most extensive programs, offered through the U of T, UBC or theBredin Institute in Alberta, are $10,000 or more.

Section 2: Findings


Skills Lab Training:Metropolitan Immigrant Settlement Association (Halifax, Nova Scotia)

The program gives IPGs the opportunity to practice communica-tion techniques, gain pharmaceutical knowledge and prepare forthe OSCE. The programis facilitated by registered pharmacists,demonstrators, and professional simulated patients.The program is a 12-16 hour course delivered over six to eightweeks in a classroom setting. It is available twice a year in thespring and fall.

International Pharmacy Graduate On-Site Program:Metropolitan Immigrant Settlement Association (Halifax, Nova Scotia)

The On-Site Program is an on-the-job program designed to famil-iarize IPGs with the professional pharmacy environment inCanada. It introduces them to interactions among patients, phar-macists, and pharmacy technicians.The program can be taken on a full-time or part-time basis andtypically takes 14 weeks to complete. It should be taken after suc-cessful completion of the PEBC evaluating exam.

Figure 2—14 (continued)Bridging Programs and Courses Available to IPGs in Canada

Awareness and Usage of Bridging ProgramsAbout one-half (52%) of surveyed IPGs indicated that they were aware of the availablebridging programs. Given that there are currently no available bridging programs inQuebec, awareness of bridging programs was lowest there, with only 37% of IPGs living inQuebec saying they were aware of bridging programs.

Bridging programs are using many different venues to publicize themselves among IPGs.The university-based programs appear to be well publicized through the provincialpharmacy regulatory authorities, provincial pharmacy associations, as well as throughemployers and immigrant settlement agencies. The other (non-university-based) programsare generally more reliant on word-of-mouth, and some use other venues of advertising,including libraries and faxes to pharmacies.

Overall, representatives of the bridging programs felt that through these methods they arereaching the target group of potential IPGs in their geographic areas. One programprovider felt that the methods being used work well for those who have recently arrived inCanada, but may not be reaching those who have been in Canada for many years, havebecome somewhat disconnected from the pharmacy system, and are hoping to now enterthe Canadian pharmacy workforce.

Among IPG survey respondents, 60% have never participated in an IPG bridging program,and have no plans to register for one in the future. About one-fifth (21%) of IPGs have hadsome involvement with an IPG bridging program with 14% indicating they havesuccessfully completed one.

Section 2: Findings


31

Bridging Program/Course Cost of Tuition

University of Toronto, Canadian Pharmacy Skills I & II $13,000.00

Bredin Institute, International Pharmacy Bridging Program $12,000.00

University of British Columbia, Canadian Pharmacy Practice Program $10,000.00

Agro Health Associates, OSCE Preparatory Course $2,000.00

Emerald Educational Services, Communication Skills for the Practice ofPharmacy $350–$700

University of Toronto, Enhanced Language Training for IEHPs Free of charge

Metropolitan Immigrant Settlement Association, Skills Lab Training Free of charge

Metropolitan Immigrant Settlement Association, IPG On-Site Program Free of charge

Assessment Centre for Internationally Educated Nurses Professional Development Centre, Orientation to the Canadian Health Care System

Free of charge

Figure 2—15Tuition Costs of Bridging Programs and Courses for IPGs

Source: IPG Bridging and Support Program Factsheets

Section 2: Findings


The majority (61%) of IPG survey respondents who had participated in an IPG bridgingprogram had attended U of T’s CPS I and CPS II. UBC’s CP3 program was the second mostcommon response (7%), followed by the International Pharmacy Bridging Program offeredat the Bredin Institute Centre for Learning in Alberta (5%).

Representatives from the bridging programs and courses have, over recent years, all seentheir enrolment numbers either remain steady or, more commonly, grow. This trend isexpected to continue in the near future, as nearly all respondents expect their numbers tocontinue to increase.

Representatives from the bridging programs and courses stated that most IPGs follow theprograms to completion, and those few learners who do not complete the programs do soas a result of personal rather than professional reasons. One respondent, however,suggested that IPGs might leave mid-way through a program, when they feel they aresufficiently prepared to pass the OSCE. In many of these cases, however, these IPGs arenot successful at the OSCE and do return to complete the program. In general, however,across all programs, most IPGs were said to be completing their programs.

Reasons IPGs Do or Do Not Participate in a Bridging ProgramIPGs who have participated in a bridging program most often do so in order to helpprepare for the PEBC examinations. 37% of IPGs stated that they were primarilyundertaking the IPG program to help prepare for the exams, whereas 20% stated that theywere taking the program primarily to improve their pharmacy skills and knowledge, or tomeet provincial licensing/registration requirements.

Figure 2—16Experience of IPGs with Canadian Bridging Programs

n=1,067Source: IPG Survey Q14

Never participated in an IPG bridging program andhave no plans to register for one in the future

Successfully completed an IPG bridging program

Participated in an IPG bridging program in thepast, but did not complete all the requirements

Currently participating in an IPG bridging program

Registered for, but no yet started, an IPG bridging progam

Don’t know/Unsure

0% 10% 20% 30% 40% 50% 60% 70%

60%

14%

3%

2%

2%

20%

Section 2: Findings


33

Figure 2—17Primary Reason Cited for Having Participated in an IPG Bridging Program

n= 219Source: IPG Survey Q15b

To help prepare for the PEBC examinations

To improve my pharmacy skills and knowledge

To meet provincial licensing/registration requirements

To understand the roles and responsibilities ofbeing a pharmacist in Canada

Don’t know/Unsure

Other

0% 5% 10% 15% 20% 25% 30% 35% 40%

20%

20%

11%

8%

5%

37%

Figure 2—18Reasons Cited for Having Not Participated in an IPG Bridging Program

n= 634Source: IPG Survey Q16As a result of multiple responses, totals may add up to more than 100%.

Did not need it

Not aware of any IPG bridging programs

Did not have the money to take an IPG bridging program

No IPG bridging programs in my area

IPG bridging program was too long/ involved too much time

Could not take the IPG bridging program becauseof family commitments

Did not meet all the requirements of the IPG bridging program

IPG bridging program seemed too difficult

Don’t know/Unsure

0% 10% 20% 30% 40% 50% 60%

27%

17%

14%

9%

7%

51%

3%

1%

6%

Section 2: Findings


At the same time, 51% of IPGs who have no experience with bridging programs selected“they did not need it” as the most common reason for not participating in an IPG bridgingprogram. Other common reasons included IPGs not being aware of the bridging programs(27%), IPGs not having the money to take an IPG bridging program (17%), or there beingno available bridging program in their geographic area (14%).

In the Toronto IPG focus group, while not all IPGs had taken the U of T bridging program,there was a sense among most of the participants that the program was useful and helpful.Some felt, however, that they did not need the program. As one participant stated, “thethings you need to know you learn in the pharmacy, not from books.”

In the Edmonton focus group, no IPGs had taken a bridging program. While IPGs weregenerally aware of the Alberta program offered through the Bredin Institute, and somewere familiar with U of T’s IPG program, they had generally not participated in theseprograms, either for financial reasons or because they felt that they did not need it. One IPG did not take the Bredin program because he or she could not meet the program’srequirement that they pass the Evaluating Examination.

Perceived Effectiveness of Bridging ProgramsIPGs appear to be benefiting from bridging programs in a variety of ways. IPGs withexperience in the bridging programs generally stated that many components of theprograms were effective or very effective. As shown in Figure 2-19, information receivedabout pharmaceutical care, applied therapeutics, and the roles and responsibilities ofpharmacists in Canada were all rated as effective or very effective by over three-quarters of IPGs who had taken the programs.

Key informants, including those from the programs themselves, echoed the commentsmade by IPGs regarding the perceived benefits of bridging programs. They felt that theprograms provided IPGs with information and practical knowledge to help addresscultural differences, communication skills, and to provide important information relatedto pharmaceutical care. Overall, key informants felt the programs aided IPGs’ transition toCanadian pharmacy practice, and were invaluable in assisting in the licensure process.

The programs also claim higher PEBC examination success rates among programcompleters. The U of T CPS program has reported that among IPGs who have successfullycompleted all components of the program, 96% have been successfully licensed.22 Keyinformants interviewed for the study also stated that the bridging programs at U of T andUBC were particularly effective in providing information to help IPGs to obtain licensureand practise as pharmacists in Canada. As there is currently no national accreditationsystem for IPG bridging programs and courses, the extent to which all programs aremeeting the needs of IPGs is not known.

Several key informants noted, however, that the existing bridging programs are notappropriate for all IPGs. Some courses were felt to be inappropriate for those coming withextensive relevant pharmacy experience and fewer cultural barriers, such as, for example,


Section 2: Findings


35

experienced pharmacists coming from the United Kingdom. One key informant suggestedthat the applicability of the programs be evaluated on a case-by-case basis, rather than theprograms being mandatory (although exemptible), as is currently the case in Ontario.

Perceived Gaps in Program DeliveryAlmost half (48%) of IPG respondents indicated that they felt there is a need for additionalbridging programs or other supports for IPGs while they are becoming licensed/registeredas pharmacists. While the existing bridging programs are largely seen as effective, they arenot seen as accessible across Canada. Many key informants felt that IPGs outside ofToronto and Vancouver have limited access to such programs. Major areas of the country,including Quebec, Atlantic Canada (outside Halifax) and others, could benefit from betteraccess to similar programs. The prospect of using computer-based delivery for theprogram was felt to be a possible solution to addressing this gap.

Effective/VeryEffective

Not Very Effective/Somewhat Effective

Don’t Know/Not Applicable

Information you received aboutpharmaceutical care (diseases and therapeutics)

83% 7% 10%

Information you received aboutapplied therapeutics 80% 9% 11%

Information you received on theroles and responsibilities ofpharmacists in Canada

79% 12% 9%

Information you received aboutthe licensing/registrationprocess and requirements

73% 15% 12%

Ability to meet your peers 73% 17% 11%

Information you received aboutworkplace behaviour and expectations in Canadian pharmacies

69% 18% 13%

Ability to interact with established practitioners andpharmacists

65% 26% 9%

Assistance in getting your pharmacist license/registrationin Canada

63% 23% 14%

Respect for your prior experience and education 57% 32% 11%

Figure 2—19Perceived Effectiveness of IPG Bridging Program Components

n= 219Source: IPG Survey Q15c

Section 2: Findings


The cost of the programs is also a limitation for some IPGs. While some large employerswill sponsor IPG participation in bridging programs, many IPGs do not have employersponsorship. Some focus group members indicated that they did not take bridgingprograms because the costs were too high and, as some of the programs are full-time, theyare unable to work while enrolled.

Some key informants felt that more government support could help to address at leastsome of the costs borne by IPGs in taking the programs. Several providers of bridgingprograms and courses similarly noted that financial support to help with tuition and livingcosts would assist many IPGs to take their programs.

One key informant noted that the focus of the bridging programs was such that it did notadequately prepare IPGs for working in hospitals or other health care facilities.

Working in CanadaAs demonstrated earlier, most IPGs expect that they will, at some point, work aspharmacists after settling in Canada.

The majority of surveyed IPGs indicated that they have tried to find work as either apharmacist (72%) or a pharmacy technician (61%) since arriving in Canada. Despite themany challenges evident throughout the licensing process, 70% of IPG survey respondentsreported that they have at some point worked as a pharmacist in Canada. While the surveyfindings may not fully represent those IPGs who are completely disconnected frompharmacy in Canada (and who would not have heard about the opportunity to participatein the survey), they demonstrate that many IPGs do go on to practise, despite the manychallenges of settling in a new country and obtaining licensure.

Profile of Employment of IPGs

IPG Hired as: All Employers*

Health care Facilities

Chain, banneror franchise Independent

Full-time Licensed Pharmacist 25% 19% 27% 27%

Part-time Licensed Pharmacist 12% 4% 12% 20%

Casual/Locum/Relief Licensed Pharmacist 19% 7% 30% 11%

Intern 20% 19% 26% 13%

Student 14% 13% 18% 10%

Volunteer 6% 4% 5% 10%

Hospital Resident — 0% — —

Pharmacy Technician 16% 16% 18% 13%

Figure 2—20Employers Who Have Hired IPGs For Different Positions (During 2005–2007)

n=315Source: Employer Survey Q1Percentages were calculated excluding “don’t know” category.*Includes employers that categorised themselves as being an “other” type of pharmacy

Section 2: Findings


37

Domestic Pharmacy Graduate Hired as:

All Employers*

Health care facility

Chain, banneror franchise Independent

Full-time Licensed Pharmacist 65% 59% 75% 53%

Part-time Licensed Pharmacist 37% 26% 43% 38%

Casual/Locum/Relief Licensed Pharmacist 42% 46% 46% 36%

Intern 25% 25% 34% 10%

Student 48% 54% 54% 36%

Volunteer 9% 8% 7% 12%

Hospital Resident 4% 14% — —

Figure 2—21Employers Who have Hired Domestic Pharmacy Graduates For Different Positions (During 2005-2007)

n=315Source: Employer Survey Q1Percentages were calculated excluding “don’t know” category.*Includes employers that categorised themselves as being an “other” type of pharmacy

A significant minority of pharmacy employers have hired IPGs recently. About four in 10(44%) of surveyed pharmacist employers indicated that they had hired at least one IPGduring the past three years. As demonstrated in Figure 2-20, employers are most likely tohire IPGs as full-time licensed pharmacists, but many are also hiring IPGs for otherpositions, including as interns and casual/locum/relief pharmacists. 16% of surveyedemployers had hired at least one IPG as a pharmacy technician over the last three years.

Figure 2-21 shows the proportion of employers who hired domestic graduates fordifferent positions.

Figure 2-22 illustrates the immigration or residency status of IPGs when they were madeoffer(s) of employment. IPGs are most often made an offer of employment while they arepermanent residents or landed immigrants. Many IPGs are also offered employment whenthey are full Canadian citizens.

Employers are making offers of employment to IPGs at various stages of the licensureprocess, most commonly after the Evaluating Exam, or after the IPG had worked for up tofive years in Canada as a licensed pharmacist. Figure 2-23 illustrates at what step in thelicensing/registration and practice process IPGs were when employers made their offers ofemployment.

IPGs are finding work in a variety of different types of pharmacies in Canada. As reportedearlier, 70% of IPG survey respondents indicated that they have worked at some point as apharmacist in Canada. As shown in Figure 2-24, while over one-half (52%) of these IPGshave worked as pharmacists for pharmacies that are franchises or part of chains, 34% haveworked in independent pharmacies, 12% in health care facilities, and 2% in otherpharmacies.

IPGs tend to find work in pharmacies in Canada’s cities. However, a large proportion ofIPGs is working as pharmacists in many mid-size or smaller cities, not just in the largesturban centres. For those IPG respondents who indicated that they have worked as apharmacist in Canada, Figure 2-25 outlines the size of the community where theirpharmacy was located.

Many IPGs are resettling within Canada to work as pharmacists. Of those IPG respondentswho indicated that they had worked as a pharmacist in Canada, 31% said that they had tomove away from the city or province where they first settled in Canada in order to work asa pharmacist.

Many IPGs are finding work as pharmacy technicians. Among surveyed IPGs 46% statedthey had worked as a pharmacy technician at some point since arriving in Canada.Working as a pharmacy technician can be an interim, short-term position that IPGs use toget experience until they can become licensed pharmacists. However, some IPGs areworking as pharmacy technicians as a result of not being able to achieve their goal ofbecoming a pharmacist.

Section 2: Findings


Figure 2—22Percentage of IPGs Hired at Different Stages of Immigration (as reported by hiring employers 2005–2007)

n=131Source: Employer Survey Q2bCategories are mutually exclusive; however employers may have more than one IPG in each category.

Permanent resident/landed immigrant

Canadian citizen

In Canada under a temporary work permit

In Canada under a student visa

Application for permanent residency approved

In Canada on visitor’s visa

Not yet applied for entry to Canada

Other immigration status (e.g., refugee)

Don’t know/Unsure

0% 5% 10% 15% 20% 25% 30% 35% 40%

2%

1%

25%

34%

24%

6%

4%

3%

2%

Section 2: Findings


39

For many IPGs, working as a pharmacy technician is a frustrating disappointment. Focusgroups revealed that many IPGs working as pharmacy technicians were negative abouttheir current position. One IPG stated that it leads to a loss of identity to have to regressfrom the type of position they were able to hold in their home country.

Figure 2—23Percentage of IPGs Hired at Different Stages of Licensure Process (as reported by hiring employers 2005–2007)

n=131Source: Employer Survey 2cCategories are mutually exclusive; however employers may have more than one IPG in each category.

Successfully completed the PEBC Evaluation Examination

Had practised for 0–5 years as a registered/ licensed pharmacist in Canada

Was in the process of fulfilling other provincial licensing /registration requirements

Successfully completed Part I of the PEBC Qualifying Examination

Had not completed any licensing/registration requirements or examinations

Successfully completed Part II of the PEBC Qualifying Examination

Had completed part or all of an IPG bridging program

Successfully received provincial licensure/registration to practice

but not yet practising

Had practised for 6 or more years as a registered/licensed pharmacist in Canada

Don’t know/Unsure

0% 2% 4% 5% 6% 8% 10% 12% 14% 16% 18%

16%

13%

11%

11%

11%

8%

8%

6%

5%

12%

Section 2: Findings


Figure 2—25Size of the Community Where IPGs Have Worked as Pharmacists

n=747Source: IPG Survey Q22

Urban centre of 500,000 people and over

Urban centre of 100,000 to less than 500,000 people

Urban centre of 5,000 to 100,000 people

Rural area (less than 5,000 people)

0% 5% 10% 15% 20% 25% 30% 35% 40%

32%

28%

4%

37%

Figure 2—24Types of Pharmacies Where IPGs Have Worked as Pharmacists in Canada

n=747Source: IPG Survey Q21a

34%

12%

52%

2% other

Chain, banneror franchisepharmacy

Independent community pharmacy

Health care institution (hospital, long term care)

Source: IPG survey Q21an=747

Perceptions of EmployersAmong those surveyed employers who had not hired an IPG within the last three years(Figure 2-26), the most common reasons included that they have not had any jobapplications from IPGs (35% of employers), or have not done any recent hiring ofpharmacists (32%). A much smaller proportion of these employers gave reasons related tothe quality of IPGs’ résumés (5%), language proficiency (5%), or qualifications (4%).

Section 2: Findings


41

Figure 2—26Reasons Given by Employers For Having Not Hired Any IPGs During the Last 3 Years

n=184Source: Employer Survey Q3

Have not had any job applications from IPGs

Have not done any recent hiring of pharmacists

Not sure how to find IPGs to hire

Resumes of IPG applicants did not meet typicalCanadian standards

IPG applicants lacked sufficient English/French language proficiency

IPG applicants did not meet qualifications for position

Patients/clients are less receptive to/acceptingof IPGs

Would require too high a level of investment inretraining and supervising

Liability/insurance concerns

Other

Don’t know

0% 5% 10% 15% 20% 25% 30% 35% 40%

35%

32%

8%

5%

5%

4%

3%

2%

0.40%

6%

1%

Likely/VeryLikely Neutral Unlikely/Very

Unlikely Don’t Know

Pharmacy manager or supervisor 13% 8% 62% 18%

Staff pharmacist 25% 23% 37% 14%

Pharmacy technician orassistant 25% 20% 43% 13%

Figure 2—27Likelihood that Employers would Hire an IPG in the Next 3 Years for DifferentPositions


Section 2: Findings


As show in Figure 2-27,only one-quarter (25%) of surveyed employers expected, over thenext three years, to hire an IPG as either a staff pharmacist or a pharmacy technician/assistant. A smallerproportion (13%) expected to hire an IPG in the next three years as a pharmacy manageror supervisor.

Of those employers in focus groups who had not employed IPGs in the past, most saidthat this was a result of not needing to hire additional workers. One employer noted thathis or her pharmacy lacked the resources to train and supervise an IPG, implying that anIPG would require more training or supervision than a domestically educated graduate.

Overall, employers were more likely to be neutral or to disagree with statementssuggesting that IPGs had particular needs compared to Canadian pharmacy graduates.They were more likely to disagree that IPGs require more supervision or training thanCanadian graduates, and did not agree that IPGs need specialized support to meet entry-to-practice standards or bridging programs to successfully practice pharmacy in Canada.

StronglyAgree/Agree Neutral Strongly

Disagree/Disagree Don’t Know

IPG employees require more supervision than Canadian graduates 16% 19% 49% 16%

IPGs require specialized support in order to meet Canadian entry-to-practice standards and become licensed/registered

7% 20% 56% 17%

IPG employees require more trainingthan Canadian graduates 15% 22% 42% 22%

IPG require specialized bridging education to successfully practisepharmacy in Canada

8% 19% 56% 17%

Figure 2—28Employer Perceptions of the Needs of IPG Employees


Key informants from provincial pharmacy regulatory authorities, associations, and largepharmacy chains were asked if pharmacy employers generally had any concerns related tohiring IPGs. Some key informants mentioned that employers may, at times, have thefollowing concerns:• Language issues, or even strong accents, can be a concern, particularly for those

outside of large cities;• Employers feel that IPGs are reluctant to leave big cities for employment in smaller

communities, where they often have less support and fewer opportunities for strongties to ethnic communities.

• There is a feeling that there are cultural and language barriers between IPGs andpatients, particularly outside of large urban areas. Employers may feel that IPGs willnot be able to relate to their patients.

Section 2: Findings


43

Benefits of Hiring IPGsEmployers were divided on the extent to which they agreed that employing IPGs generallyprovided benefits for their pharmacy, (Figure 2-29).

Employers were generally positive about the amount of experience that IPGs bring topharmacy practice and were more likely to agree (39%) than disagree (17%) that IPGs aremore experienced than Canadian graduates. Similarly, employer focus group participantscommented that many IPGs were extremely knowledgeable about drug interactions andspecific chemical properties. One participant noted that often IPGs “know by heartinformation that Canadian pharmacists have to look up in reference material.” Ininterviews, key informants noted that IPGs are often older and more experienced inpharmacy practice than domestically educated pharmacists.

Surveyed employers did not generally agree that IPGs provide important cultural orlanguage benefits to their pharmacy’s patients/clients, or valuable new or alternativehealth information and approaches to practice. However, in focus groups, someemployers noted that a more multicultural society benefits from a more multiculturalpharmacy workforce. Pharmacies with IPGs often offer patients more cultural andlanguage diversity. This was felt to result in improved service and patient care, particularlyin large urban centres.

StronglyAgree/Agree Neutral Strongly

Disagree/Disagree Don’t Know

IPGs are generally more experiencedthan new Canadian graduates 39% 19% 17% 25%

IPG employees provide access to newpatients/clients 24% 30% 27% 19%

IPG employees provide valuablenew/alternative health informationand approaches to practice

18% 31% 34% 18%

IPG employees provide important cultural or language benefits to my patients/clients

18% 27% 39% 16%

IPG employees are more willing thanCanadian graduates to work in under-served areas

17% 14% 34% 34%

Figure 2—29Employer Perceptions of the Benefits of IPG Employees


Section 2: Findings


Barriers or Challenges to IPG SuccessAs demonstrated in Figure 2-30, IPGs most often felt that various aspects of the licensingprocess were the major barriers to their success in the Canadian pharmacy workforce.Many felt that the financial burden of the licensing process was particularly challenging(44% identifying this as a barrier or significant barrier). In addition, 41% of IPGs felt thatthe length of time required for the licensing process was a barrier, while 35% said that thelack of resources to assist in preparation for licensing was a barrier.

In addition to the challenges of completing the often difficult process of becoming licensed topractice, Figure 2-30 also illustrates other challenges related to finding employment andworking as a pharmacist in Canada that were identified by both employers and IPGs. Thesechallenges to IPGs’ success in the pharmacy workforce are generally related to two areas:communication skills and cultural differences that impact practice.

Communication SkillsCommunication skills in pharmacy practice include not only general English (or French)language proficiency, but also relate to knowledge of Canadian idioms and expressions,and to proficiency in communicating with clients and other health care providers.

Employers overwhelmingly identified communication issues as the major barrier affectingIPGs’ success. About two-thirds (67%) of surveyed employers identified a lack ofproficiency in communicating effectively with patients/clients and a lack of proficiency inspoken and written English/French (67% and 60% respectively) as barriers to IPGs success.Further, 55% of employers felt that a lack of proficiency in communicating effectively withother pharmacists was a barrier for IPGs.

Employers who had hired IPGs in the last three years were slightly less likely to feel thatcommunication skills were a barrier for IPGs. Among those who had recently hired an IPG,58% felt that written English/French were barriers, compared to 63% of those employerswho had not recently hired an IPG. Similarly, 63% of employers who had hired IPGs saidspoken English/French was a barrier, compared to 71% of those who had not. Employerswho had recently hired IPGs were also less likely to see barriers for IPGs incommunicating effectively with patients/clients (62% versus 72%), and in communicatingeffectively with other pharmacy staff (52% versus 60%).

Communication barriers were also identified in interviews with bridging and supportprogram providers. Some felt that IPGs may overestimate their communication skills. This may, in part, be a result of IPGs passing standardized fluency tests, but stilldemonstrating some weaknesses in communication. A prerequisite for licensure as apharmacist in Canada is a demonstrated fluency in English or French. However, fluency isdemonstrated through the use of standardized tests (Test of English as a ForeignLanguage, International English Language Testing System), and these tests do not indicatethe level of proficiency in pharmacy-related terminology, profession-specific language, orsocio-linguistic communication skills. Pharmacists rely almost exclusively on speaking,listening, reading and writing in order to gather information on which to base theirpatient care. Standardized tests may not measure the ability to undertake these importantfunctions in pharmacy practice.23

23. Austin, Z., Rocchi Dean, M. Bridging education for foreign-trained professionals: the International Pharmacy Graduate(IPG) Program in Canada. Teaching in Higher Education. Jan 2006;11(1):19-32.

Section 2: Findings


45

Figure 2—30Employer vs. IPG Perceptions of the Barriers to IPGs’ Success in the CanadianPharmacy Workforce: Proportion Stating Each Factor is a Barrier

Source: Employer Survey Q5, IPG Survey Q24

Financial burden of licensing/registration process

Length of time required for licensing/registration process

Lack of resources to assist in preparing forlicensing/registration exams

Lack of practical experience working in a Canadian pharmacy

Lack of information about how to find pharmacist employment in Canada

Provincial differences in licensing/registration requirements specific to IPGs that limit

labour mobility

Lack of profession-specific technical and procedural knowledge

Lack of understanding of the Canadian models of pharmacy practice

Lack of understanding of the Canadian health care system

Cultural differences between Canada and the IPG’s country of origin

Lack of proficiency in applying clinical knowledge in a Canadian setting

Lack of proficiency in communicating effectively with patients or clients

Lack of accurate information regarding licensing/registration process

Lack of proficiency in spoken English or French

Lack of proficiency in written English or French

Lack of proficiency in communicating effectivelywith other pharamcy staff/health care providers

Lack of drug and therapeutic knowledge

0% 10% 20% 30% 40% 50% 60% 70% 80%

EmployerIPG

32%44%

30%41%

25%35%

33%43%

14%25%

22%24%

28%20%

40%20%

34%19%

35%17%

35%15%

67%13%

21%12%

66%12%

60%11%

55%9%

23%7%

Section 2: Findings


Some employers in focus groups felt that communication barriers related to writing inEnglish were not especially significant factors, as these could be overcome over time, andthat pharmacists do not generally use written English on the job. In some instancesemployers prioritized the pharmacy skills of the IPG over current communication skills. Asone employer stated, “Having someone who can do the job is better than having someonethat can ‘talk the talk.’”

Cultural Differences that Impact Pharmacy PracticeThe role of the pharmacist in Canada has undergone significant change over the past twodecades. Increasingly, pharmacists are responsible for providing disease and druginformation to patients and other health care providers, and monitoring and follow-up ofdrug therapy. This practice evolution has not occurred in some countries, where pharmacyhas stayed closer to its traditional role of primarily dispensing drugs and medicines.

This evolution, and differences in health care systems generally, has meant that pharmacypractice in Canada can be very different than in other countries. Pharmacists in othercountries may have different roles and expectations, particularly in terms of their roles inrelation to physicians and patients. As a result, IPGs may suffer from “double shock,”which is “the need to simultaneously adapt to new cultures at both the personal andprofessional levels”.24

Over one-third (35%) of employers felt that cultural differences between Canada and IPGs’country of origin acted as a barrier to IPG success. Furthermore, 40% of employers feltthat IPGs’ lack of understanding of Canadian models of pharmacy practice was a barrier,and 35% of employers felt that a lack of proficiency in applying clinical knowledge in aCanadian setting was a barrier. Finally, 34% of employers felt that a lack of understandingof the Canadian health care system was a barrier to IPG success. These barriers were alsoidentified in employer focus groups, particularly as they related to IPGs’ lack of familiaritywith the Canadian health care system.

Sometimes communication challenges and cultural differences overlap. Some keyinformants and bridging/support stakeholders noted in interviews that IPGs can facechallenges in relation to Canadian gender roles and communicating with other health careproviders. For example, it was noted that some female IPGs from more traditional culturesare unaccustomed to communicating with male patients/clients. Similarly, some IPGs aremore accustomed to working in more hierarchical, and less team-based, workenvironments, and struggle with Canadian workplace norms.

Facilitators of IPG SuccessIPGs were asked how effective they felt available information and supports were inhelping them to become pharmacists in Canada. As shown in Figure 2-31, IPGs found avariety of supports and information to be useful. In particular, IPGs felt that “informationabout the process of becoming licensed/registered to practise as a pharmacist” andstructured practical training were effective (65% and 63%). Information and servicesprovided by the PEBC (58%) and bridging programs (55%) were also identified aseffective. Among those who had completed a bridging program, 74% rated the program aseffective.

24. Austin, Z. Mentorship and mitigation of culture shock: foreign trained pharmacists in Canada. Mentoring and Tutoring.April 2005;13(1):133-49.

Section 2: Findings


47

Figure 2—31IPGs’ Perceptions of Effectiveness of Facilitators of Success in Working as aPharmacist in Canada

Source: IPG Survey Q25Percentages were calculated excluding “Don’t know” responses.

Information about the process of becoming licensed/registered to practise as a

pharmacist in Canada

Structured practical training

Information and services provided by the Pharmacy Examining Board of Canada (PEBC)

Bridging programs for IPGs

Available English and/or French language training

Resources to help prepare for examinations

Practice opportunities provided by employers

Information and services provided by the Provincial Regulatory Authorities

Mentoring opportunities

IPG communities or professional networks

Support programs available for immigrants (not necessarily designed for IPGs)

Other (e.g., information/support from peersand family members, financial assistance

with cost of education/other expenses)

0%10% 20% 30% 40% 50% 60% 70% 80% 90%100%

EffectiveNeutralNot effective

65% 21% 14%

63% 18% 19%

58% 22% 19%

55% 23% 22%

53% 23% 24%

53% 20% 27%

53% 17% 30%

52% 23% 25%

51% 23% 26%

47% 21% 32%

36% 21% 43%

81% 4% 15%

Other types of supports or information that were effective were also provided by surveyedIPGs, and most often included information/supports from peers and family members, andfinancial assistance for the cost of education/other expenses.

Employers were also asked to rate the effectiveness of supports and information inhelping IPGs to become pharmacists in Canada. While many employers did not have anopinion on the effectiveness of the supports, 69% of those who did rated structuredpractical training as effective. Bridging programs for IPGs and practice opportunitiesprovided by employers were also rated effective by 65% and 64% of employers,respectively.

Section 2: Findings


Structured practical training

Bridging programs for IPGs

Practice opportunities provided by employers

Available English and/or French language training

Mentoring opportunities

Preparatory resources for examinations

Information about the process of becoming licensed/registered to practise as a

pharmacist in Canada

Information and services provided by the Pharmacy Examining Board of Canada (PEBC)

Information and services provided by the Provincial Regulatory Authorities

Available support programs for immigrants (not necessarily designed for IPGs)

IPG communities or professional networks

Other

Figure 2—32Employers’ Perceptions of the Effectiveness of Different Types of Facilitatorsin Assisting IPGs in Successfully Becoming Pharmacists in Canada

n=315Source: Employer Survey Q6Percentage calculated excluding “I don’t know” response

0%10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

EffectiveNeutralNot effective

69% 19% 12%

65% 23% 13%

64% 23% 13%

63% 24% 13%

62% 24% 14%

61% 26% 13%

61% 26% 13%

60% 25% 16%

57% 25% 17%

51% 30% 19%

48% 35% 17%

33% 4% 63%

The availability of supports specifically for IPGs within the workplace is fairly limited. For thoseIPG respondents who had worked as a pharmacist in Canada, only 23% reported that thepharmacy, company, or organization that they worked for offered any supports, services orprograms specifically designed for IPGs. These supports included practical training programsto help with licensure process/to gain experience in a Canadian pharmacy (42%) and financialassistance with the cost of licensure/registration, education and/or living expenses (35%).

The majority of IPG respondents (60%) feel that there is a need for employers to offerspecialized support programs specifically designed for IPGs. Forty-one per cent ofrespondents reported that “more opportunities for practical training” were needed. At16%, “more employment opportunities” was the next most common response, followedby “financial assistance with education/other expenses while pursuing licensure” (15%).

Section 3: Key Findings


49


Settling In CanadaWhile IPGs come from many different areas and backgrounds, IPGs are typically fromSoutheast Asia or the Middle East, have an undergraduate pharmacy degree as theirhighest level of education, and have experience working as a pharmacistThe majority (74%) of IPGs come to Canada from Southeast Asia (typically India, Pakistan,the Philippines) or the Middle East (typically Egypt, Iran, Jordan). Generally, IPGs havecompleted an undergraduate pharmacy program as their highest level of education, and85% have experience working as a pharmacist before coming to Canada.

There is no single source of information that outlines the complete process andrequirements to becoming licensed/registered to practise as a pharmacist in CanadaIPGs have indicated that before settling in Canada they are able to obtain usefulinformation from the PEBC, the provincial pharmacy regulatory authorities, as well asfriends, family, and other sources. However, both IPGs and employers indicate that, whileindividual sources of effective information exist, there is no single source which outlinesall the requirements and provincial differences in the licensure process. IPGs often feelthat they do not have all the necessary information prior to making their decision to cometo Canada, and may be making settlement decisions based on incomplete information orincorrect assumptions. For example, while many IPGs feel that they should settle in largercities where there are likely to be more job opportunities, evidence suggests jobopportunities might be more plentiful in smaller cities or towns.

Most IPGs expect they will eventually work as pharmacists in CanadaOver three-quarters (78%) of IPGs indicated that when they settled in Canada theyexpected they would, at some point, work as a pharmacist in Canada. While someexpected that they may have to work as pharmacy technicians or, in Quebec, return touniversity to take some schooling, most planned to become pharmacists.

Licensing/Registering to Practise as a Pharmacist in CanadaPass rates for IPGs in each of the PEBC examinations are lowDuring the years of 2002-2006, combining all examination sittings, the IPG pass rate was59% for the Evaluating Exam, 48% for the Qualifying Examination Part I, and 45% for theQualifying Examination Part II (the OSCE). These pass rates are significantly lower thanthose of Canadian graduates.

The pass rate for IPGs on their first attempt at each of these exams is even lower, with 43%of IPGs passing the Qualifying Exam Part I and only 39% of IPGs passing the QualifyingExam Part II on their first attempt.

A significant proportion of IPGs are often taking more than one attempt at PEBCexaminationsWhile only a quarter (26%) of unique IPGs generally make more than one attempt at theEvaluating Exam, almost one-half of unique IPGs are taking more than one attempt at theQualifying Examination Part I (46%) and Part II (48%). By comparison only a smallproportion of Canadian graduates (less than 10%) are required to take more than oneattempt at either portion of the Qualifying Examination.



IPGs are finding the licensure process to be very time-consumingWhile about one-quarter (24%) of IPGs completed their licensure in one year or less, 58%required two years or more. The average amount of time to complete licensure was 26months, and the median time was 24 months. 41% of IPGs also report that the timerequired to complete the licensure process was a major barrier to their eventual success inpracticing pharmacy in Canada.

IPGs rated the Qualifying Examination Part II (the OSCE) as the most difficult step in thelicensing process IPGs felt that the PEBC Qualifying Examination, particularly the OSCE, was the mostdifficult part of the licensing process. About three-quarters of surveyed IPGs felt that theQualifying Examination Part I (74%) and Qualifying Examination Part II (77%) were“difficult” or “very difficult”, with 19% rating Qualifying Examination Part I and 28% ratingQualifying Examination Part II as “very difficult”, respectively. The Evaluating Examinationwas also rated as “difficult” or “very difficult” by a majority (58%) of IPGs. Finding apractical training position was rated as “very difficult” by 26% of IPGs, and “difficult” by28% of IPGs.

Both IPGs and employers feel that additional programs or supports are needed tosupport IPGs on the path to licensureMost IPGs and most employers feel that additional supports are needed to support IPGson the path to licensure. Employers most strongly favour language and communicationskills support, while IPGs suggest more practical training opportunities. However,employers also suggest practical or clinical training as a key additional support.

Bridging ProgramsBridging programs and courses are generally seen as beneficial to the IPGs whoparticipate in themBridging programs are formal, post-degree programs of study designed to address gapsbetween an IPG’s education or experience and standards of pharmacy practice in Canada.Nine identified and documented bridging programs and courses are available to assistIPGs in becoming licensed and practising pharmacists in Canada. These programs rangefrom intensive university-based programs in Toronto and Vancouver to short examinationpreparatory or pharmacy communication programs.

IPGs feel they benefit from bridging programs in a variety of ways, including beinginformed about pharmaceutical care, applied therapeutics, and the roles andresponsibilities of pharmacists in Canada.

Not all IPGs have access to, or are making use of, the existing supportsSixty per cent of IPGs surveyed indicated that they had never participated in an IPGbridging program and have no plans to do so in the future. Bridging programs are arelatively new phenomenon in Canada, and there are many areas of the country whereIPGs do not have access to bridging programs and courses. Even those IPGs who are inclose proximity to a bridging or support program do not always participate in theprograms, however. The majority of IPGs feel they do not need to take the bridging orsupport programs.



51

Working in CanadaDespite the challenges of licensure and settling in Canada, IPGs are generally findingwork in pharmacyThe majority (70%) of IPG survey respondents indicated that they have at some pointworked as a pharmacist in Canada. Similarly, 44% of surveyed employers indicated thatthey have hired at least one IPG during the last three years.

IPGs are most often made an offer of employment while they are permanent residents orlanded immigrants. Employers are making offers of employment to IPGs at various stagesof the licensure process, most commonly after the Evaluating Examination, or after theIPG has already worked for up to five years in Canada as a licensed pharmacist.Interestingly, a sizeable proportion of employers indicated that they are not aware of theimmigration status (25%) or the stage in the licensure process (12%) of IPGs that theyhave hired.

Many IPGs are finding work as pharmacy technicians in CanadaForty six per cent of IPG survey respondents indicated that they had at one time worked asa pharmacy technician in Canada. This often occurs either as an interim step in theprocess of becoming a pharmacist, or because of difficulties in becoming licensed orfinding employment as a pharmacist.

Some IPGs however, feel they have become “trapped” in the position of pharmacytechnician, and cannot afford the time and money required to become licensed to practiceas a pharmacist. In some cases, working as a pharmacy technician is disappointing andfrustrating for IPGs, who feel a sense of a loss, or diminishment of identity.

While IPGs face many challenges to success in the Canadian pharmacy workforce,communication skills are seen by employers as a particularly severe barrierWhile IPGs identified the cost and time involved in the licensure process as the mostsignificant barriers to their success, employers were most likely to identify barriers relatedto communication skills. About two-thirds (67%) of surveyed employers identified a lackof proficiency in communicating effectively with patients/clients and a lack of proficiencyin spoken English/French (67%) as barriers to IPGs’ success. Furthermore, 55% ofemployers felt that a lack of proficiency in communicating effectively with otherpharmacists was a barrier.

IPGs do not generally believe that the English/French language fluency requirements oflicensure are a major barrier to their success. The research suggests that communicationcan be a challenge for IPGs, however, particularly in relation to different cultural norms incommunication and to pharmacy-specific language.

Employers do not generally see particular advantages or disadvantages to hiring IPGsOverall, employers did not feel that there were particular advantages or disadvantages toemploying IPGs. While some employers note the considerable experience that IPGs bringto the job, there is less recognition of the cultural advantages IPGs bring to practice.

Research Appendices


Research Appendices

Appendix A: BibliographyAgro Health Associates. OSCE Preparatory Course. Available from: http://www.agrohealth.com/courses.htm.Accessed September 2007. Alberta College of Pharmacists. Applicants who received their pharmacy degree outside of Canada. Availablefrom: http://pharmacists.ab.ca/registration_licensure/pharmacists.aspx?id=4870. Accessed August 2007.

Austin Z. Geographical migration, psychological adjustment, and re-formation of professional identity: thedouble-culture shock experience of international pharmacy graduates in Ontario (Canada). InternationalMigration Review, 2003.

Austin Z, Rocchi Dean M. Bridging education for foreign-trained professionals: the international pharmacygraduate (IPG) program in Canada. Teaching in Higher Education. Jan. 2006;11(1):19-32.

Austin Z. Mentorship and mitigation of culture shock: foreign-trained pharmacists in Canada. Mentoringand Tutoring: Partnership in Learning. April 2005;13(1):133-49.

Austin Z. Continuous professional development and foreign-trained health care professionals: Results of aneducational needs assessment of international pharmacy graduates in Ontario (Canada). Journal of Social andAdministrative Pharmacy. 2003; 20(6):143-51.

Austin Z, Rocchi Dean M. Development of a curriculum for foreign-trained pharmacists seeking licensure inCanada. Pharmacy Education. 2004; 14(9): 1-9.

Austin Z, Rocchi Dean M. Bridging education in pharmacy: the international pharmacy graduate program inOntario, Canada. American Journal of Pharmaceutical Education. 2004; 68(5):1-11.

Austin Z, Galli M. Assessing communicative competency of international pharmacy graduates in Ontario,Canada. Journal of Social and Administrative Pharmacy. 2003;20(6):225-31.

Austin Z, Galli M, Diamantouros A. Development of a prior learning assessment for pharmacists seekinglicensure in Canada. Pharmacy Education. June 2003;3(2):87-96.

Blackburn & Associates. An environmental scan of pharmacy technicians (roles and responsibilities, educationand accreditation, and certification). Moving Forward: Pharmacy Human Resources for the Future, October2006.

Bredin Institute. International pharmacy bridging program. Available from:http://www.bredin.ab.ca/TrainingPrograms/International%20Pharmacy%20Bridging%20Program/default.aspx.Accessed September 2007.

British Columbia College of Pharmacists. Guide to becoming a pharmacist in British Columbia. Available from:http://www.bcpharmacists.org/registration/. Accessed August 2007

Gaither CA., et al. Should I stay or should I go? The influence of individual and organizational factors onpharmacists’ future work plans. Journal of American Pharmacy Association. March/April 2007; 47(2):165-73.

Government of Canada. The Canadian Immigration Integration Project. Available from:http://ciip.accc.ca/default.aspx?DN=782,32,Documents. Accessed September 2007.

Hao X, Wuliji T. Global Pharmacy Workforce and Migration Report. International Pharmaceutical Federation,2006.

Humphrey GE, Quinones AC. Addressing the pharmacist shortage through a cooperative internship programfor foreign pharmacy graduates. Journal of American Pharmacy Association. March/April 2007; 47(2):191-96.

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53

Metropolitan Immigrant Settlement Association. Internationally Educated Professionals. Available from:http://www.misa.ns.ca/iep.php. Accessed September 2007.

National Association of Pharmacy Regulatory Authorities. Making the move: The mutual recognition agreementfor pharmacists in Canada. Rogers Media — Healthcare & Financial Publishing, February 2002.

National Association of Pharmacy Regulatory Authorities. National Statistics. Available from:http://www.napra.org/docs/0/86/363.asp. Accessed August 2007.

Ontario College of Pharmacists. Pharmacy graduates from other Nations: e-factsheet. Available from:http://www.newontariopharmacist.com. Accessed August 2007.

Ordre des pharmaciens du Quebec. Admission à la pratique: Diplomés hors du Québec. Available from:http://www.opq.org/fr/admission/diplomes_hors_quebec. Accessed August 2007.

Pugsley J. Recognition of the international experience and credentials of immigrants. The Pharmacy ExaminingBoard of Canada, May 5, 2005.

Registered Nurses Professional Development Centre. Orientation to the Canadian health care system. Availablefrom: http://www.cdha.nshealth.ca. Accessed September 2007.

Tessier A. Prescription for learning: Communication skills for the practice of pharmacy. Emerald EducationServices, March 31, 2004.

University of British Columbia. Canadian Pharmacy Practice Programme. Available from:http://www.pharmacy.ubc.ca/cppd/programs/CP3_Program.html. Accessed September 2007.

University of Toronto. International Pharmacy Graduate Program. Available from: http://www.ipgcanada.ca/.Accessed September 2007.

Vision Research. The pharmacy technician workforce in Canada: Roles, demographics and attitudes (part I),responses to National Survey of Pharmacy Technicians and Assistants. Canadian Pharmacists Association, March2007.

Vision Research. The pharmacy technician workforce in Canada: Roles, demographics and attitudes (part II),responses to National Survey of Pharmacists (Owners and Managers). Canadian Pharmacists Association,March 2007.

Research Appendices


The pharmacy profession would like to understand the challenges facing international pharmacy graduates (IPGs) whowant to work in Canada. We are doing this survey to collect information from people living in Canada who receivedtheir undergraduate pharmacy degree in another country. This research will help us find ways to deal with the problemsmany IPGs face.

This survey is part of a large research project, called Moving Forward: Pharmacy Human Resources for the Future. Theproject is led by the Canadian Pharmacists Association and its partners. It is funded by the Government of Canada’sForeign Credential Recognition program.

The Moving Forward project has hired R. A. Malatest and Associates Ltd., a private research firm, to carry out this surveyand other research.

The research firm will keep all the survey information private and confidential. Individuals will not be identified orlinked to their responses.

Thank you for taking part in this important research.

If you prefer to complete the survey online, please go to the following Web site address:

http://survey.malatest.com/PHARMACIST_IPG

Your password for the online survey is the number in the bottom right-hand corner of this survey.

SURVEY OF INTERNATIONAL PHARMACY GRADUATES (IPGS)

Objective of the Survey:

To obtain the perspectives of international pharmacy graduates (IPGs) on the issues andchallenges they face in the process of:

• deciding to become a pharmacist in Canada, • getting licensed/registered to practice in Canada, and • integrating into the Canadian pharmacy workforce.

Who will participate in the survey?

The study will include the following groups of IPGs: (1) people who are working as pharmacists,(2) people not employed as pharmacists, and (3) people who are in the process of becominglicensed or registered.

Confidentiality: Information provided by survey respondents will be kept confidential. Results will be providedto the Canadian Pharmacists Association in summarized form only, without identifying individualrespondents.

Do you have questions?

If you have any questions about the survey, or the research in general, please contactSarah Leger of R.A. Malatest and Associates Ltd., at (toll-free) 1-888-689-1847 [email protected]

Appendix B: Survey Questionnaires

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55

� No � If NO, END survey

� Yes � If YES, CONTINUE survey

1. Did you complete your undergraduate pharmacy education in a country other than Canada?

The following questions ask about your experiences before settling in Canada.

� The United States of America

� Mexico

� The United Kingdom

� Europe (not including the United Kingdom)

� Russia and Commonwealth of IndependentStates (Belarus, Georgia, etc.)

� Australia

� Africa

� The Caribbean (e.g., Trinidad and Tobago, Jamaica, West Indies)

� South America

� China

� South-East Asia (e.g., the Philippines, India,Pakistan, Bangladesh)

� Other Asia (e.g., Japan, Korea)

� Middle East (e.g., Egypt, Israel, Iran)

� Other (please specify): ____________________

� Don’t Know / Unsure

2. In what part(s) of the world did you complete your undergraduate pharmacy education? [Check ALL that apply.]

� Bachelor’s degree

� Master’s degree

� PhD

� Pharm. D.

� Other, please specify: ____________________

3a. What pharmacy degree(s) did you complete outside of Canada?[Check ALL that apply.]

BEFORE SETTLING IN CANADA

CONTACT INFORMATION

Name: � Dr. � Mr. � Mrs. � Ms. � Miss.

(First)__________________________________________ (Last) __________________________________________________

Telephone: (_______) ____________________________ Fax: (________)__________________________________________

E-mail: ________________________________________ @______________________________________________________

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4b. If YES, please indicate your primary area of practice before settling in Canada:

� Hospital

� Community

� Military

� Pharmaceutical industry

� Government

� Academic institution

� Other

� No � If NO, GO TO Question #5

� Yes � If YES, for how many years? ________________



3b. In what year did you complete your undergraduate pharmacy degree? ________________

� English

� French

� Other, please specify: _______________

3c. What was the language of instruction?

4a. Before settling in Canada, did you practise as a pharmacist in another country?

5. Before settling in Canada, did you expect that you would at some time work as a pharmacist in Canada?

6. How effective were the following sources of information in helping you make your decision topractise as a licensed/registered pharmacist in Canada?

Did not consult

Not very Effective

SomewhatEffective Effective Very

EffectiveDon’tKnow

Canadian embassy or consulate � � � � � �Friends or peers living in Canada � � � � � �Friends or peers living outside of Canada � � � � � �Family living in Canada � � � � � �Family living outside of Canada � � � � � �Pharmacy recruiter � � � � � �Pharmacy employer � � � � � �Pharmacy Examining Board of Canada (PEBC) � � � � � �Provincial Pharmacy Licensing Authority / Regulatory Body � � � � � �Canadian Pharmacists Association (CPhA) � � � � � �Provincial government(s) of Canada � � � � � �Federal government of Canada (e.g., Citizenship and

Immigration Canada, others) � � � � � �

Other, please specify: � � � � � �

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57

LICENSING AND REGISTRATION

The next questions are about the process of becoming licensed/registered to practise as a pharmacist inCanada. The “licensing/registration process” refers to any of the steps required to become licensed or registered to practise as a pharmacist in your province.



7. Do you have your license/registration to practise as a pharmacist in a Canadian province?

8a. [If you DO HAVE your license/ registration to practise in a province of Canada]:

What year did you get your license/registration to practise in a province

of Canada? _____________

8c. How long did the licensing/registration process take?

Please estimate the amount of time between when you first had your documents evaluated by thePharmacy Examining Board of Canada (PEBC) and when you became licensed/registered to practiseas a pharmacist in a Canadian province.

Licensing/registration process took ______________ months

8d. Are you trying to get licensed/registered in another province?

[NOW GO TO Question #11]

8b. In which province or territory did you get your first license/registration?

� British Columbia

� Alberta

� Saskatchewan

� Manitoba

� Ontario

� Quebec

� Nova Scotia

� New Brunswick

� Prince Edward Island

� Newfoundland & Labrador

� Yukon

� Northwest Territories

� Nunavut

� YES, in the province of ________________________________

� NO

9. [If you DO NOT HAVE your license / registration to practise in a province of Canada]

Will you try to get your license/registration? [Check ONE only]

10a. [If you ARE TRYING OR WILL TRY to get your license / registration to practise in a province ofCanada]

In what province are/will you try to get licensed/registered? ____________

� I am not currently trying to get licensed/registered and have nointention of getting licensed/registered. . . . . . . . . . . . . . . . . . . . . � GO TO Question #12a

� I am not currently trying to get licensed/registered but intendto try in the future . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . � CONTINUE Survey

� I am currently trying to get licensed/registered . . . . . . . . . . . . . . � CONTINUE Survey

10b. What steps of the licensing/registration process have you successfully completed? [Check ALL that apply.]

� Have not completed any licensing/registration requirements

� Completed Pharmacy Examining Board of Canada (PEBC)Evaluating Examination . . . . . . . . . . . . . . . . . . . . . . . � # of exam attempts? _______

� Completed Part I of the PEBC Qualifying Examination(Multiple Choice Questionnaire) . . . . . . . . . . . . . . . . . . � # of exam attempts? _______

� Completed Part II of the PEBC Qualifying Examination(Objective Structured Clinical Examination) . . . . . . . . . . � # of exam attempts? _______

� Completed language fluency requirements

� Completed in-service or practical training(as a student or intern etc.)

� Completed provincial jurisprudence examination (exam on legal information)

� Completed other province-specific licensing/registration requirements (e.g. Ontario IPG Program requirements, Quebec Diploma Equivalency education)

� Submitted application for license/registration


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11. In your opinion, how easy or difficult were each of the following steps of the licensing/registrationprocess that you have undertaken?

Very Easy Easy DifficultVery

DifficultDon’t Know /

Have not Taken

a) Having documents examined by PEBC � � � � �b) The PEBC Evaluating Exam � � � � �c) The PEBC Qualifying Exam Part I

(Multiple Choice Questionnaire) � � � � �d) The PEBC Qualifying Exam Part II

(Objective Structured Clinical Examination) � � � � �e) Meeting English or French fluency

requirements � � � � �

f) Finding a practical training position � � � � �g) Provincial jurisprudence examination � � � � �h) Meeting other educational requirements in

your province (e.g., Ontario IPG program requirements, Quebec diploma

� � � � �

i) Getting licensed/registered in your province � � � � �

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59

BRIDGING PROGRAMS

Bridging programs are available to help IPGs become pharmacists in Canada. In this survey, “bridging program”means a formal, post-degree program of study designed to address gaps between an IPG’s education orexperience and standards of pharmacy practice in Canada. Please note that a bridging program is not apost-graduate degree program, such as a Pharm D or Master’s program.

Bridging programs can include:

• University-based programs• Community-college based programs• Private vocational college-based programs• Programs offered by private consultants and others.

� Yes

� No


12a. Are you currently aware of any bridging programs available for IPGs in Canada?

12b. [If YES] What bridging programs for IPGs are you aware of? [Please LIST]

� Yes

� No


13a. Do you feel that there is a need for additional bridging programs or other programs to support IPGswhile they are becoming licensed/registered as Canadian pharmacists?

13b. [If YES] What additional bridging programs or other supports do you feel are needed for IPGs?

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

Research Appendices


� Never participated in an IPG bridging program and have no plans to register for one in the future.

� Registered for, but not yet started, an IPG bridging program.

� Currently participating in an IPG bridging program.

� Participated in an IPG program in the past, but did not complete all the requirements.

� Successfully completed an IPG bridging program.


14. Please describe your experience with Canadian bridging programs designed for IPGs. [Check ONLY ONE.]

� To help prepare for the PEBC examinations

� To meet provincial licensing/registration requirements

� To improve your pharmacy skills and knowledge

� To understand the roles and responsibilities of being a pharmacist in Canada

� Other, please specify: ______________________________________________


15b. What was your main reason for taking the IPG bridging program? [Check ONLY ONE.]

15a. If you HAVE participated in or registered for an IPG bridging program, which IPG bridging programwas it?

[If you HAVE NOT participated in an IPG bridging program, GO TO Question #16.]

[If you HAVE participated in an IPG bridging program CONTINUE Survey]

____________________________________________________________________________

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61

15c. Please rate the effectiveness of the following aspects of the IPG bridging program you participated in.

[NOW GO TO Question #17]

Not Very Effective

SomewhatEffective Effective

Very Effective

Don’t Know / Not Applicable

a) Information you received on the roles and responsibilities of pharmacists in Canada � � � � �

b) Information you received on technical and procedural knowledge required by pharmacists in Canada

� � � � �

c) Information you received about thelicensing/registration process and requirements � � � � �

d) Information you received about workplace behaviour and expectations in Canadian pharmacies � � � � �

e) Information you received about pharmaceutical care (diseases and therapeutics) � � � � �

f) Information your received about applied therapeutics � � � � �

g) Ability to meet your peers � � � � �h) Respect for your prior experience and education � � � � �i) Ability to interact with established practitioners and

pharmacists � � � � �

j) Assistance in getting your pharmacistlicence/registration in Canada � � � � �

16. If you have NOT participated in or registered for an IPG bridging program, why not? [Check ALL that apply.]

� Did not need it

� Not aware of any IPG bridging programs

� No IPG bridging programs in my area

� Did not have the money to take an IPG bridging program


� IPG bridging program seemed too difficult

� Could not take the IPG bridging programbecause of family commitments

� IPG bridging program was too long / involvedtoo much time

� Did not meet all of the admissionrequirements of the IPG bridging program

Research Appendices


EMPLOYMENT IN CANADA

17. What is your current employment status? [Check ONLY ONE.]

18. Since arriving in Canada, have you ever tried to find work in Canada as:

� Employed as a pharmacist

� Employed as a pharmacy intern

� Employed as a pharmacy student

� Employed as a pharmacy technician

� Volunteering in a pharmacy

� Currently employed but not in a field related to pharmacy

� Currently unemployed but looking for work in a pharmacy

� Currently unemployed but looking for work in a field unrelated to pharmacy

� Currently unemployed and not looking for work

� Retired

� Other

a. A pharmacist � Yes � No

b. A pharmacy technician � Yes � No

19. Since arriving in Canada, have you ever worked in Canada as:

a. A pharmacist � Yes � No

b. A pharmacy technician � Yes � No

[Questions #20 to #23 are only for people who HAVE WORKED as a pharmacist in Canada.]

[If you have NEVER worked as a pharmacist in Canada, GO TO Question #24.]

20. [If you HAVE WORKED as a pharmacist in Canada]:

Did you have to move away from the city or province where you first settled to get work as a pharmacist in a pharmacy?

� Yes

� No


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63

23a. [If you HAVE WORKED as a pharmacist in Canada]:

Does/did this pharmacy, company or organization offer any supports, services or programs that arespecifically designed for IPGs?

� Yes

� No


21a. [If you HAVE WORKED as a pharmacist in Canada]:

Please tell us the types of pharmacies you have worked in as a pharmacist in Canada: [Check ALL that apply.]

� Health care institution (hospital, long term care)

� Chain, banner or franchise pharmacy

� Independent community pharmacy

� Other

21b. Please tell us the type of pharmacy where you worked the longest as a pharmacist in Canada:[Check ONLY ONE.]

� Health care institution (hospital, long term care)

� Chain, banner or franchise pharmacy

� Independent community pharmacy

� Other

22. [If you HAVE WORKED as a pharmacist in Canada]:

How big was the community where this pharmacy is/was located?

� Rural area (less than 5,000 people)

� Urban centre of 5,000 to 100,000 people

� Urban centre of 100,000 to less than to less than500,000 people

� Urban centre of 500,000 people and over

23b. IF YES, what did it offer?

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

Research Appendices


Don’tknow

a) Lack of understanding of Canadian health care system 1 2 3 4 5 �

b) Lack of understanding of Canadian models of pharmacy practice 1 2 3 4 5 �

c) Lack of proficiency in applying clinical knowledge in a Canadian setting 1 2 3 4 5 �

d) Lack of drug and therapeutic knowledge 1 2 3 4 5 �

e) Lack of profession-specific technical and procedural knowledge (e.g., computer software) 1 2 3 4 5 �

f) Lack of proficiency in written English or French 1 2 3 4 5 �

g) Lack of proficiency in spoken English or French 1 2 3 4 5 �

h) Lack of proficiency in communicating effectively with patients/clients 1 2 3 4 5 �

i) Lack of proficiency in communicating effectively with other pharmacy staff and other health care providers 1 2 3 4 5 �

j) Lack of practical experience working in a Canadian pharmacy 1 2 3 4 5 �

k) Lack of accurate information regarding licensing/registration process 1 2 3 4 5 �

l) Lack of resources to assist in preparing for licensing/registration exams 1 2 3 4 5 �

m) Length of time required for licensing/registration process 1 2 3 4 5 �

n) Financial cost of licensing/registration process 1 2 3 4 5 �

o) Lack of information about how to find work as a pharmacist in Canada 1 2 3 4 5 �

p) Provincial differences in licensing/registration requirements specific to IPGs that make it difficult to move from one province to another 1 2 3 4 5 �

q) Cultural differences between Canada and your country of origin 1 2 3 4 5 �

24. To what extent do you feel the following things may have acted as barriers to your success inworking as a pharmacist in Canada?

Circle a number from 1 to 5, where ‘1’ means ‘Not a barrier at all’ and ‘5’ means ‘A very significant barrier’?

24.r)Please tell us about other barriers, if any:

A verysignificant

barrier

Not a barrierat all

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

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65

Don’tknow

a) Information about the process of becoming licensed/registered to practise as a pharmacist in Canada 1 2 3 4 5 �

b) Bridging programs for IPGs 1 2 3 4 5 �

c) Resources to help prepare for examinations 1 2 3 4 5 �

d) Support programs available for immigrants (not necessarily designed for IPGs) 1 2 3 4 5 �

e) Practice opportunities provided by employers 1 2 3 4 5 �

f) Structured practical training 1 2 3 4 5 �

g) IPG communities or professional networks 1 2 3 4 5 �

h) Mentoring opportunities 1 2 3 4 5 �

i) Available English- and/or French-language training 1 2 3 4 5 �

j) Information and services provided by the Pharmacy Examining Board of Canada (PEBC) 1 2 3 4 5 �

k) Information and services provided by the Provincial Regulatory Authorities 1 2 3 4 5 �

l) Other (please specify) 1 2 3 4 5 �

25. In your opinion, how effective are the items listed below in helping you become a pharmacist inCanada?

Circle a number from 1 to 5, where ‘1’ means ‘Not effective at all” and ‘5’ means ‘Very effective’?

Not effectiveat all

Veryeffective

26a. Do you feel there is a need for employers to offer any kind of specialized support programs specifically designed for IPGs?

� Yes

� No


26b. If YES, what is needed?

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

Research Appendices


GENERAL INFORMATION

27. How old are you?

� 18 to 24 years of age





� 65 years of age or older

28.Gender:

� Male

� Female

29. In which province or territory do you currently live?

� British Columbia

� Alberta

� Saskatchewan

� Manitoba

� Ontario

� Quebec

� New Brunswick

� Nova Scotia

� Prince Edward Island

� Newfoundland & Labrador

� Yukon

� Northwest Territories

� Nunavut

� Do not live in Canada

30a. What is your current immigration or residency status?

� Not yet applied for entry to Canada

� In Canada under a temporary work permit

� In Canada under student visa

� In Canada under a visitors visa

� Permanent resident / landed immigrant

� Application for permanent residency approved, but not yet resident in Canada

� Canadian citizen

� Other immigration status (for example, refugee)


30b. How many years have you been living in Canada? (If less than one year, please put “0”.)

__________________ years

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67

To complete online, please go to the following URL: http://survey.malatest.com/PHARMACIST_IPG Your password to access the online survey is the number located on the bottom right-hand corner of thefirst page of the survey. If you have any questions, please contact:

R.A. Malatest & Associates Ltd.400 – 294 Albert StreetOttawa, ON K1P 6E6Toll-free telephone: 1-888-689-1847

THANK YOU FOR COMPLETING THIS IMPORTANT SURVEY

Please return your completed survey in the enclosed postage-paid envelope or by one of thefollowing methods:

Toll-free fax: 1-866-288-1278 Mail: R.A. Malatest & Associates Ltd.400 – 294 Albert Street

Toll-free telephone: 1-877-688-5051 Ottawa, ON K1P 6E6

31. Is your first language English, French or another language?

� English

� French

� Other, please specify: _______________

32. Would you be willing to participate in a focus group or one-on-one interview to discuss the issuesoutlined in this survey?

� Yes

� No

[NOTE: You can earn Continuing Education Credits by participating in a focus group]

Research Appendices


The pharmacy profession needs your help in collecting information to better prepare the pharmacy workforce for thehealth care needs of the future. The research is part of Moving Forward: Pharmacy Human Resources for the Future,a collaborative initiative led by the Canadian Pharmacists Association and its national pharmacy organization partners.This initiative was launched in 2005 and is funded by the Government of Canada’s Foreign Credential Recognitionprogram.

The Canadian Pharmacists Association (on behalf of the Moving Forward Initiative) has commissioned R.A. Malatest andAssociates Ltd., a private research firm, to undertake research exploring the human resources issues and challengessurrounding the integration of international pharmacy graduates (IPGs) in the Canadian pharmacy workforce.

The research includes a survey of pharmacy employers across Canada, to gain the broad range of employerperspectives from community, hospital, long-term care, and other types of pharmacies.

Your pharmacy has been selected to participate in this national survey. This short confidential survey should becompleted by the director, manager or owner of your pharmacy (this location only) or the most senior personresponsible for human resources at your pharmacy (this location only). Thank you for your involvement in thisimportant research.

Objective of the SurveyTo obtain the perspectives of employers on issues and workplace challenges facing internationalpharmacy graduates in Canada. The study will include the perspectives of employers who employinternational pharmacy graduates, as well as those who do not.

ConfidentialityInformation provided by survey respondents will be kept confidential, and results will be provided tothe Canadian Pharmacists Association in summarized form only, without identifying individualrespondents.

QuestionsIf you have any questions about the survey, or the research in general, please contact Sarah Leger ofR.A. Malatest and Associates Ltd., at (toll-free) 1-888-689-1847 or [email protected]

RESEARCH ON INTERNATIONALPHARMACY GRADUATES SURVEY OF PHARMACY EMPLOYERS

CONTACT INFORMATION

Name: � Dr. � Mr. � Mrs. � Ms. � Miss.

(First)__________________________________________ (Last) __________________________________________________

Job Title: ______________________________________ Organization: ___________________________________________

Telephone: (_______) ____________________________ Fax: (________)__________________________________________

E-mail: ________________________________________ @______________________________________________________

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69

This survey is designed to obtain your perspectives on issues related to internationalpharmacy graduates (IPGs). For the purposes of this survey, an “international pharmacygraduate” is defined as anyone who obtained their undergraduate pharmacy educationoutside of Canada.

International Pharmacy Graduates Canadian Graduates

0 1–4 5–9 10–49 50+Don’tknow

0 1–4 5–9 10–49 50+Don’tknow

Full-timeRegistered/LicensedPharmacist

� � � � � � � � � � � �

Part-timeRegistered/LicensedPharmacist

� � � � � � � � � � � �

Casual/locum/reliefRegistered/LicensedPharmacist

� � � � � � � � � � � �

Intern* � � � � � � � � � � � �

Student* � � � � � � � � � � � �

Pharmacy Technician orAssistant � � � � � � � � � � � �

Volunteer � � � � � � � � � � � �

Hospital Resident � � � � � � � � � � � �

*Although the designations “intern” and “student” may vary according to province, an intern typically has ahigher degree of autonomy regarding scope of practice and may work in an unsupervised capacity, usuallywith the condition that a pharmacist be physically present on the premises.

If your pharmacy is part of a chain or has multiple locations, please frame your surveyresponses with respect to your (single) pharmacy location only.

1a. How many IPGs and domestic pharmacy graduates has your pharmacy hired for each of the followingpositions during the past three years?

Please count any individuals hired by your pharmacy only once, and only for the position for which they were first hired.

Research Appendices


The following questions apply only to those survey respondents who have hired IPGsduring the past three years. If no IPGs were hired during this period, please proceed toquestion #3.

2a. From what area(s) of the world did the IPGs hired within the last three years first obtain theirundergraduate pharmacy education(s)? [CHECK ALL THAT APPLY.]

Number of IPGs currently employed as registered/licensedpharmacists:

� The United States of America

� Mexico

� The United Kingdom

� Europe (not including the United Kingdom)

� Russia and Commonwealth of IndependentStates (e.g. Belarus, Georgia)

� Australia

� Africa

� The Caribbean (e.g., Trinidad and Tobago,Jamaica, West Indies)

� South America

� China

� South-East Asia (e.g., the Philippines, India,Pakistan, Bangladesh)

� Other Asia (e.g., Japan, Korea)

� Middle East (e.g., Egypt, Israel, Iran)

� Other (please specify): ____________________


2b. What best describes the immigration or residency status of these IPGs when your pharmacy madethe offer(s) of employment?

[CHECK ALL THAT APPLY IF YOU HAVE HIRED ANY IPGs DURING PAST THREE YEARS.]

� Not yet applied for entry to Canada

� In Canada on visitor’s visa

� In Canada under a temporary work permit

� In Canada under student visa

� Permanent resident / landed immigrant

� Application for permanent residency approved, but not yet resident in Canada

� Canadian citizen

� Other immigration status (e.g. refugee)


1b. How many IPGs does your pharmacy currently employ?

Number of IPGs currently employed as pharmacy technicians orassistants:

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71

2c. At what step in the licensing/registration and practice process* were these IPGs when yourpharmacy made the offer(s) of employment?

*The “licensing/registration process” refers to any of the necessary steps IPGs must take to becomelicensed/registered to practise as a pharmacist in your province. This can include the Pharmacy ExaminingBoard of Canada (PEBC) Evaluating Examination, the PEBC Qualifying Examinations, or any specific step orrequirement as set out by your province’s regulatory authority such as structured practical training,language fluency, and jurisprudence examination.

[CHECK ALL THAT APPLY IF YOU HAVE HIRED ANY IPGs DURING PAST 3 YEARS.]

� Had not completed any licensing/registration requirements or examinations

� Successfully completed the PEBC Evaluating Examination

� Had completed part or all of an IPG bridging program*

� Successfully completed Part I of the PEBC Qualifying Examination

� Successfully completed Part II of the PEBC Qualifying Examination

� Was in the process of fulfilling other provincial licensing/registration requirements (e.g. meetingdesignated language fluency, structured practical training, jurisprudence, Quebec Diplomaequivalency)

� Successfully received provincial licensure/registration to practice, but not yet practising

� Had practised for 0-5 years as a registered/licensed pharmacist in Canada

� Had practised for 6 or more years as a registered/licensed pharmacist in Canada


* For the purpose of this survey, a “bridging program” is a formal, post-degree program of studyspecifically designed to address gaps in an IPG’s education or experience and standards of pharmacypractice in Canada and its provinces. Please note that this is not a post-graduate degree program.

2d. Does your pharmacy or head office actively recruit IPGs from outside of Canada?

� Yes

� No


[SKIP TO QUESTION 4]

Research Appendices


3. [IF YOU HAVE NOT HIRED ANY IPGS WITHIN THE LAST THREE YEARS] For what reason(s) have younot hired any IPGs in your pharmacy during the past three years? [CHECK ALL THAT APPLY.]

� Have not done any recent hiring of pharmacists

� Have not had any job applications from IPGs

� IPG applicants did not meet qualifications forposition

� IPGs applicants lacked sufficient English/Frenchlanguage proficiency

� Resumes of IPG applicants did not meet typicalCanadian standards (e.g. format, grammar,fluency)

� Don’t Know

4a. In your opinion, is there a need for additional programs/services designed to support IPGs whilethey are on the path to licensure/registration as Canadian pharmacists?

� Yes

� No

� Don’t Know

4b. [IF YES] What additional programs/services do you think are needed?

_______________________________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

4c. What kind of support, if any, does your location offer specifically to IPGs (beyond generalemployment training or orientation)? [CHECK ALL THAT APPLY.]

� Liability / insurance concerns

� Not sure how to find IPGs to hire

� Would require too high a level of investmentin retraining and supervising.

� Patients/clients are less receptiveto/accepting of IPGs

� Other _________________________________

� None

� Internships

� Student positions

� Language training

� PEBC examination processpreparation

� Don’t Know

� Mentoring

� Financial assistance with licensing/registrationexaminations

� Tuition support for bridging programs

� Settlement assistance (e.g. assistance with housing,transit, accessing community resources)

� Other: ______________________________________

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5. To what extent do you feel the following act as barriers to IPGs’ success in the Canadian pharmacyworkforce, with ‘1’ being ‘Not a barrier at all’ and ‘5’ being ‘A very significant barrier’?

Not a barrier A very significantat all barrier

Don’tknow

a) Lack of understanding of the Canadian health care system 1 2 3 4 5 �

b) Lack of understanding of Canadian models of pharmacypractice 1 2 3 4 5 �

c) Lack of proficiency in applying clinical knowledge in a Canadian setting 1 2 3 4 5 �

d) Lack of a drug and therapeutic knowledge 1 2 3 4 5 �

e) Lack of profession-specific technical and procedural knowledge(e.g., computer software) 1 2 3 4 5 �

f) Lack of proficiency in written English or French 1 2 3 4 5 �

g) Lack of proficiency in spoken English or French 1 2 3 4 5 �

h) Lack of proficiency in communicating effectively withpatients/clients 1 2 3 4 5 �

i) Lack of proficiency in communicating effectively with otherpharmacy staff and other health care providers 1 2 3 4 5 �

j) Lack of practical experience working in a Canadian pharmacy 1 2 3 4 5 �

k) Lack of accurate information regarding licensing/registrationprocess 1 2 3 4 5 �

l) Lack of resources to assist in preparing for licensing/registrationexams 1 2 3 4 5 �

m) Length of time required for licensing/registration process 1 2 3 4 5 �

n) Financial burden of licensing/registration process 1 2 3 4 5 �

o) Lack of information about how to find pharmacist employmentin Canada 1 2 3 4 5 �

p) Provincial differences in licensing/registration requirementsspecific to IPGs that limit labour mobility 1 2 3 4 5 �

q) Cultural differences between Canada and the IPG’s country oforigin 1 2 3 4 5 �

5r. Please provide any other potential barriers to IPG success in the Canadian pharmacy workforce,if any.

_____________________________________________________________________________________

Research Appendices


6. In your opinion, how effective are the following facilitators in assisting IPGs in successfullybecoming pharmacists in Canada, with ‘1’ being ‘Not effective at all’ and ‘5’ being‘Very effective’?

Not effective Veryat all effective

Don’tknow

a) Information about the process of becoming licensed/registeredto practise as a pharmacist in Canada 1 2 3 4 5 �

b) Bridging programs for IPGs* 1 2 3 4 5 �

c) Preparatory resources for examinations 1 2 3 4 5 �

d) Available support programs** for immigrants (not necessarily designed for IPGs) 1 2 3 4 5 �

e) Practice opportunities provided by employers 1 2 3 4 5 �

f) Structured practical training 1 2 3 4 5 �

g) IPG communities or professional networks 1 2 3 4 5 �

h) Mentoring opportunities 1 2 3 4 5 �

i) Available English- and/or French-language training 1 2 3 4 5 �

j) Information and services provided by the Pharmacy Examining Board of Canada (PEBC) 1 2 3 4 5 �

k) Information and services provided by the Provincial RegulatoryAuthorities

1 2 3 4 5 �

l) Other (please specify)1 2 3 4 5 �

* For the purpose of this survey, a “bridging program” is a formal, post-degree program of study specifically designed to address gaps in an IPG’s education or experience and standards of pharmacy practise in Canada and its provinces. Please note that this is not a post-graduate degree program.

** A “support program” can span a large range of services including language training, résume preparation, and settlement services (assistance with housing, transit and accessing community resources).

7. Please indicate your level of agreement with each of the following statements regarding IPGs, with ‘1’ being ‘Strongly Disagree” and ‘5’ being ‘Strongly Agree’.

Strongly Stronglydisagree agree

Don’tknow

a) IPG employees provide valuable new/alternative health information andapproaches to practice 1 2 3 4 5 �

b) IPG employees require more supervision than Canadian graduates 1 2 3 4 5 �

c) IPG employees provide important cultural or language benefits to mypatients/clients 1 2 3 4 5 �

d) IPGs require specialized support in order to meet Canadian entry-to-practice standards and become licensed/registered 1 2 3 4 5 �

e) IPGs are generally more experienced than new Canadian graduates 1 2 3 4 5 �

f) IPG employees require more training than Canadian graduates 1 2 3 4 5 �

g) IPG employees provide access to new patients/clients 1 2 3 4 5 �

h) IPG employees are more willing than Canadian graduates to work in under-served areas 1 2 3 4 5 �

i) IPGs require specialized bridging education to successfully practisepharmacy in Canada 1 2 3 4 5 �

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75

To complete online, please go to the following URL:http://survey.malatest.com/Pharmacist_Employer Your password to access the online survey is the number located on the bottom right-hand corner of thesurvey. If you have any questions, please contact:

R.A. Malatest & Associates Ltd.400 – 294 Albert StreetOttawa, ON K1P 6E6Toll-free telephone: 1-888-689-1847

8. Within the next three years, how likely are you to hire one or more IPGs at your pharmacy as a:

9. Which of the following best describes your pharmacy?

� Health care facility (hospital, long term care) � Independent pharmacy

� Chain, banner or franchise drug store � Other

10. Would you consider participating in a paid focus group to discuss the issues raised in this surveyin more detail?

� Yes � No

11. Part of the research being undertaken for this study includes surveys and focus groups with IPGs.Would you be willing to assist the researchers in identifying IPGs to potentially participate in thisstudy?

� Yes � No

Very Veryunlikely likely

Don’tknow

a) Pharmacy manager or supervisor 1 2 3 4 5 �

b) Staff pharmacist 1 2 3 4 5 �

c) Pharmacy technician or assistant 1 2 3 4 5 �

THANK YOU FOR COMPLETING THIS IMPORTANT SURVEY

Please return your completed survey in the enclosed postage-paid envelope or by one of thefollowing methods:

Toll-free fax: 1-866-288-1278 Mail: R.A. Malatest & Associates Ltd.400 – 294 Albert Street

Toll-free telephone: 1-877-688-5051 Ottawa, ON K1P 6E6

Research Appendices


Research on International Pharmacy Graduates – Stakeholder Interview Guide

The pharmacy profession needs your help in collecting information to better prepare the pharmacy workforce for the health care needs of the future. The research is part of Moving Forward: Pharmacy Human Resources for the Future, a collaborative initiative led by the Canadian Pharmacists Association and its national pharmacy organization partners. This initiative was launched in 2005 and is funded by the Foreign Credentials Recognition Program of Human Resources and Social Development Canada. The Canadian Pharmacists Association (on behalf of the Moving Forward Initiative) has commissioned R.A. Malatest and Associates Ltd., a private research firm, to undertake research exploring the human resources issues and challenges faced by international pharmacy graduates (IPGs) in the Canadian pharmacy workforce. The research includes a series of interviews with key informants involved with international pharmacy graduates, or with the pharmacy profession in general. Thank you for your involvement in this important research. Objective of the Survey: To obtain the perspectives of key informants on issues and challenges facing international pharmacy

graduates in Canada. Confidentiality: Information provided by respondents will be kept confidential, and results will be reported and

provided to the Canadian Pharmacists Association in summarized form only, without identifying individual respondents.

Questions: If you have any questions about the interview, or the research in general, please call Sarah Leger of

R.A. Malatest and Associates Ltd., at (toll-free) 1-888-689-1847.

Contact Information

Name: Dr. Mr. Mrs. Ms. Miss.

(First) ______________________________________ (Last)____________________________________________________

Job Title: ____________________________________ Organization:_____________________________________________

Telephone: ( _________ )__________________________ Fax: ( _______ ) _______________________________________

E-mail: ____________________________@ _______________________________________________________________

SECTION A: STAKEHOLDER INFORMATION (ALL STAKEHOLDERS)

A1a. Which of the following describe(s) your role(s) related to international pharmacy graduates or to the pharmacy profession in general?

For the purposes of this survey, an “international pharmacy graduate” is defined as anyone who obtained their pharmacy degree outside of Canada.

(CHECK ALL THAT APPLY)

Pharmacy manager/owner

Educational / training institution representative (college, university, or private training educators)

Provincial regulatory authority representative

Association representative

Settlement/Support services representative

Government representative

Organization representative

Human resources specialist

Other, Please specify:_______________________________ A1b. Please describe the extent of your experience/involvement with international pharmacy graduates (IPGs).

Appendix C: Interview Guides

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77

SECTION B: LICENSING

The first questions ask about the licensing requirements and the process by which international pharmacy graduates become licensed to practice in Canada. The “licensing process” refers to any of the necessary steps required to become licensed and practice as a pharmacist in Canada. This can include the Pharmacy Examining Board of Canada (PEBC) Evaluating Examination (for IPGs educated outside of North America only), the PEBC Qualifying Examinations, or any specific step or requirement as set out by provincial regulatory authorities such as structured practical training, fluency, and jurisprudence examination.

B1a. Do you feel that the licensing process for IPGs is appropriate and effective? (See Appendix A for details on licensing requirements per province.)

B1b. Please explain your answer:

B2. Please suggest any ways that the licensing process for IPGs could be improved.

B3. What challenges or barriers do international pharmacy graduates face in the process of obtaining licensure?

B4. What would help IPGs to overcome these challenges or barriers?

SECTION C: BRIDGING AND SUPPORT PROGRAMS AND COURSES

C1. An important part of this research is building an inventory of current and planned bridging or support services available to international pharmacy graduates. What are the programs and courses (current/planned) available to international pharmacy graduates that you are aware of?

For the purpose of this research, a “bridging program” is a formal, post-degree academic program of study designed to address gaps in education or experience and standards of pharmacy practice in Canada. Please note that this is not a post-graduate degree program. A “support program” can span a large range of services including language training, resume preparation, and settlement services (assistance with housing, transit and accessing community resources).

C2. In your view, how well do existing bridging and other support programs or courses prepare international pharmacy graduates for licensure and/or integration into pharmacy practice in Canada? (NOTE THE PROGRAMS/COURSES AND CORRESPONDING COMMENTS FOR EACH)

C3. Are there any gaps in terms of the existing programs or courses available for support or bridging of IPGs (e.g., gaps in scope, location, focus, etc)? If yes, please explain the gap(s) and potential solutions to address those gaps.

C4. What challenges or barriers do international pharmacy graduates face related to accessing or completing these courses or programs, if any?

C5. What would help to overcome these challenges or barriers?

SECTION D: IPG LABOUR MARKET

D1. What challenges or barriers are IPGs facing in finding and obtaining employment as pharmacists in Canada?

D2. What types of programs, services or resources, if any, are assisting IPGs in finding and obtaining employment? How effective are they, in your opinion?

D3. What is currently being done regarding recruiting of IPGs from outside Canada? Is this recruitment effective? How could it be improved?

D4. What challenges or barriers are IPGs facing in successfully practicing as pharmacists in Canada?

D5. Please describe any skill or training deficiencies that you have seen in the IPGs working in the Canadian pharmacy workforce.

D6. What, if any, supports or services for international pharmacy graduates are being offered by employers in Canada?

D7. How successful have these programs or supports been? Please explain your answer.

D8. What are the benefits or advantages for employers of employing IPGs?

D9 Do employers have any concerns with hiring or employing IPGS? If so, what are these concerns?

Research Appendices


SECTION E: COORDINATION

E1. What types of coordination, networking, partnerships or information-sharing (between programs, levels of government,

organizations, pharmacies etc.) are being undertaken, if any, to assist in the recruitment, licensing and/or integration of IPGs into the Canadian pharmacy workforce?

E2. Are there any current gaps or needs in terms of coordination, networking, partnerships or information-sharing that are affecting the recruitment, licensing and integration of IPGs into the Canadian pharmacy workforce?

E3. What are the barriers or challenges that prevent/limit cooperation and coordination?

GOVERNMENT (FEDERAL, PROVINCIAL, MUNICIPAL) STAKEHOLDERS

F1. What initiatives, if any, has your department undertaken with respect to access to regulated employment?

F2. Do you have any comments or concerns about the pharmacy profession’s approach to licensing of international pharmacy graduates?

F3. Can you please describe any initiative you have specifically aimed at recruiting or integrating internationally trained individuals?

RECRUITERS

F4. What specific challenges have you encountered in recruiting IPGs?

F5. What specific challenges have you encountered in enabling IPGs to become licensed in Canada?

SETTLEMENT/SUPPORT SERVICES

F6. Can you provide information on your typical clients?

F7. Can you describe your organization’s services to newcomers

F8a. Does your organization serve internationally educated pharmacists?

F8b. IF YES, can you articulate some of the challenges encountered by this particular group?

PROVINCIAL REGULATORY AUTHORITY STAFF ONLY

F9. How are IPGs made aware of the need to register with your organization?

F10. How much guidance do IPGs need through the process of getting registered? F11. Please review the relevant table in Appendix A containing details on licensing requirements for IPGs for your

province. a) Is the information accurate and up-to-date? b) From what you know, are there any expected changes to licensing requirements for IPGs for your province?

l Pharmacy Stakeholder Interview Guide

Research on International Pharmacy Graduates – Program/Support Provider Interview Guide

The Canadian Pharmacists Association has commissioned R. A. Malatest and Associates Ltd., a private research firm, to undertake research exploring the human resources challenges faced by international pharmacy graduates (IPGs) in the Canadian pharmacy workforce. The research is part of Moving Forward: Pharmacy Human Resources for the Future, an initiative launched in 2005 and funded by the Foreign Credentials Recognition Program of Human Resources and Social Development Canada.

The information collected in this interview will be used to inform this important study and initiative. The information collected will not be linked to any specific names of individuals. Your responses to all questions of opinion will be anonymous and confidential and not linked to any specific institution. Information of fact about your institution’s program(s) or course(s), such as the number of enrolled students and duration of program, may be reported with the name of your institution.

Thank you very much for your participation in this important research.

Purpose of the Research To document the processes and individual steps that IPGs must undergo between their decision to immigrate to Canada

and their successful licensure to practice in Canada.

To develop a detailed inventory of current support or bridging programs available to IPGs.

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79

To develop a basic demographic profile of international pharmacy graduates in Canada.

To conduct research to understand the attitudes and experiences of IPGs regarding their quest to achieve licensure and integrate into Canadian pharmacy practice.

Research undertaken for this study may also inform other research being undertaken by the Canadian Pharmacists Association.

Please provide the name and job title of the person participating in this interview:

Title: Mr. Mrs. Miss. Ms. Dr.

Name: _________________________________ Surname: ______________________________________

Job Title: _________________________________ E-mail: ______________________________________

Telephone: _________________________________ Fax: ______________________________________

Organization and Address: __________________________________________________________________________

____________________________________________________________________________________________________

SECTION A: RESPONDENT INFORMATION

A1. Please describe your position and role in providing bridging and/or support programs or courses for international pharmacy graduates (IPGs).

For the purposes of this survey, an “international pharmacy graduate” is defined as anyone who obtained their pharmacy degree outside of Canada.

SECTION B: PROGRAMS AND/OR SUPPORT OFFERED

B1. The following section asks detailed questions about the IPG program(s) or course(s) offered by your organization. This information will primarily be used to develop an inventory of IPG supports and programs. Do we have your consent to include any factual information you provide in this interview about your program(s) or course(s)?

B2a. For each IPG program or course currently offered by your institution, please provide the following information.

Name of Program(s) or Course(s) Type of Program or Course*

Only available for pharmacists?

(CHECK IF YES)

Only available for internationally-

educated? (CHECK IF YES)

1. *Types of programs can include, for example:

University-based program Community-college based program Private vocational college-based programs Programs offered by private consultants Others

B2b. For each IPG bridging and/or support program or course currently offered by your institution, please provide the following information.

Name of Program(s) or Course(s) Duration Full- or

Part-time?

Offered how many times per year?

# of seats available 2007 (if

applicable)

# of enrolled students (2007)

% of enrolled

students who pass the program

Check if there is a waitlist

1. %

Research Appendices


For the purpose of this study, a “bridging program” is a formal, post-degree program of study designed to address gaps in an IPG’s education or experience and standards of pharmacy practice in Canada. Please note that this is not a post-graduate degree program. A “support program” can span a large range of services including language training, resume preparation, and settlement services (assistance with housing, transit and accessing community resources).

B2c. Please detail how much students must pay to take these programs or courses.

Name of Program(s) or Course(s) Cost of Tuition per individual Other Costs (books, etc.) (Specify)

1.

B2d. How are the program(s) or course(s) funded? Is there any funding available for IPGs to assist in paying tuition or other costs? If yes, please specify what type(s) of funding is available, how much, and repayment options, if known.

B2e. What is the structure and content of each of these courses? For example, how does the program provide practical, hands-on training?

B2f. When were the program(s) and/or course(s) started? Why were they initiated? What skills gaps/needs were they developed to address?

B2g. How was the curriculum designed, developed and validated? How is it updated?

B2h. What are the specific requirements for admission to these courses or programs (e.g. language fluency, residency status, interview process, application fee, requirement that applicant has passed the PEBC Evaluating Examination, etc.)?

B3a. At what point in the licensing or practice process do IPGs typically take the programs or courses offered at your institution?

B3b. For what reason(s) do IPGs typically take the(se) program(s) or course(s)? (For e.g., to pass PEBC Qualifying exams, directed by employer, to refresh skills, etc.)

B4. What are common reasons for IPGs not completing the programs or courses at your institution (e.g. why do they typically drop out, fail, or chose only to complete some parts of the program)?

B5a. How do IPGs typically find out about your program(s) or course(s)? What methods are used to advertise or publicize the programs/courses?

B5b. In your opinion, how successful has your program been in reaching IPGs? What are the barriers to reaching IPGs? Do you feel there are IPGs who are not aware of your programs or courses who could potentially benefit from them?

B6. Have there been any significant changes to the number of IPGs in these programs or courses over the last five years? If so, what have been the changes, and why?

B7. Do you expect any change to the number of IPGs in these programs or courses in the next 5 years? If so, what change do you expect, and what are the reasons for these expected changes?

B8. Are there any planned or expected future changes to the IPG programs or courses offered at your institution? For example, does the institution plan to make any curricular changes, expand the programs, enter into partnerships, etc.?

SECTION C: OUTCOMES OF GRADUATES

C1. What skills, attitudes or knowledge do you feel IPGs take away from your programs or courses? What additional

benefits, if any, accrue to IPGs that take your programs or courses?

C2a. For each program or course offered at your institution, if applicable, can you estimate the proportion of program participants who subsequently pass the PEBC Qualifying Exams and go on to work as pharmacists in Canada?

Name of Program or Course

% of program participants who pass

Qualifying Exam Part I

Typical or average # of attempts required

to pass Qualifying Exam

Part I

% of program participants who pass

Qualifying Exam Part II

Typical or average # of attempts required to pass

Qualifying Exam Part II

% of program participants who go on to work as

pharmacists in Canada

1. % % % C2b. Does your institution formally track these types of outcomes through follow-up with former students? If so, how do you

obtain this information (e.g. self-reporting by IPGs, information provided by PRA, other)? Do students stay in contact with former instructors after their program(s) or course(s)?

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81

C3a. Have these programs or courses been subject to a review or evaluation? If so, can you please provide a copy of the

results to help inform this project? If a report cannot be provided, could you summarize the findings for us or provide us with some major findings?

C3b. Have you collected or received any client feedback on the IPG program(s) or course(s)? If so, can you provide or summarize this feedback to help inform this project?

C4. In your opinion, what additional supports or assistance would improve the outcomes of IPGs who take these programs or courses? What are the needs that are not being met by the programs or courses?

SECTION D: CHALLENGES AND NEEDS OF INTERNATIONAL PHARMACY GRADUATES

D1. In your opinion, what are the major challenges facing IPGs in successfully integrating into the workforce in Canada?

D2. What are the major skills and knowledge gaps facing IPGs as they attempt to integrate into the workforce?

D3. What skills and knowledge do IPGs need that your program(s) or course(s) cannot provide?

SECTION E: CHALLENGES OF IPG EDUCATORS

E1. Can you share some of your challenges as an educator of IPGs? These can include, for example, systemic challenges, or specific challenges encountered related to the diversity of IPGs.

E2. Do you feel that you have all the supports and assistance you need as an educator of IPGs? If not, what would assist you?

E3. Do you feel there are sufficient linkages and partnerships between your program(s) or course(s) and other pharmacists and pharmacies? Please explain your answer.

ADDITIONAL COMMENTS

F1. Do you have any other comments you would like to make about any of the issues raised in this interview?

F2. Would you be willing to distribute information about this research project to your current or former learners?

Thank you very much for your participation in this important research.

Research Appendices


International Pharmacy Graduate Employer Focus Group Moderator’s Guide

Introduction 5 min Welcome! I’d like to thank you all very much for coming to this discussion group today. My name is ____________. I am a researcher with R.A. Malatest & Associates Ltd, a Canadian research and evaluation company. Our purpose is to get your insights and understanding of issues surrounding the integration of international pharmacy graduates in Canada. We are hearing from international pharmacy graduates and pharmacy employers such as yourselves through a series of discussion groups across Canada. As many of you know, we have also done surveys with both international pharmacy graduates and pharmacy employers. This research is part of a larger research project called Moving Forward: Pharmacy Human Resources for the Future. The project is led by the Canadian Pharmacists Association and its partners. It is funded by the Government of Canada’s Foreign Credential Recognition program. First of all, I would like to take a minute to explain how we will proceed with this discussion:

The focus group should take about one and a half hours. There will be two parts to the focus group. The first part will be an open discussion, the latter will be focused on your comments on some findings from our survey of employers.

The session will be audio and/or video taped. The recording equipment is [equipment location]. We tape focus groups to make sure the results we present are accurate. [Indicate mirror and observers.]

Anything you say will remain confidential—that is, your name will not be associated with anything you say, and we will just use first names.

I’d like to point out that there are no right or wrong answers and that I am not looking for group agreement on each topic. We would like to hear a diversity of answers and perspectives.

I would like to remind you that, for the purposes of the study, international pharmacy graduates are defined as those who obtained their undergraduate pharmacy degree outside of Canada. So, if everyone is comfortable, we will now get started. Self-Intro 5 min Let’s start the discussion by going around the table and having everybody introduce themselves. Please tell us your first name, plus a little bit about your position in the pharmacy and the size and type of pharmacy (independent, chain, hospital, etc.)

m loyment min 1. Has your organization employed any internationally educated pharmacists? This may include IPGs hired as licensed

pharmacists, or to fulfill their training requirements. 2. For those that have: What do you think have been the benefits of employing IPGs? [Prompt, if necessary: To what extent do they bring specific types of experiences or knowledge? To what extent do they help in communicating with clients/customers from ethnic communities? Other benefits?] 3. For those that have not: What are the reasons that you have not employed any IPGs? 4. In your opinion, what have been some of the challenges of, or barriers to, employing IPGs, if any? [Moderator to keep lists on flipchart] Training/Supports/Resources 25 min Next, I would like to hear your perspectives on training, supports, and resources specifically designed to help international pharmacy graduates become integrated into pharmacy practice in Canada. This could include, for example, academic

Appendix D: Focus Group Moderator Guides

Research Appendices


83

bridging programs, internal corporate training, examination prep courses, formal mentorship programs or other types of training. 1. What sort of formal training/supports/resources, if any, has your organization offered specifically for IPGs? How

effective have these been, in your opinion? 2. What other types of training/supports/resources do you think should be made available to IPGs in order to better

integrate them into the Canadian pharmacy workforce? Who should provide/fund these types of supports, in your opinion?

[Probe for things like what specific skills or competencies need to be developed, where they need to be developed, how they can be developed.] 3. What role do you think that you as an employer can take to help integrate IPGs into pharmacy practice? What do you

need to assist you in helping IPGs? 4. Overall, do you generally rely on the system of training, supports and resources outside of your pharmacy to help IPGs

with any knowledge, experience or cultural issues/gaps, or do you expect that you as an employer will be responsible for addressing these issues?

Exercise A 20 min Hand out Exercise A (following sheet). Now, I would like you to have a look at the handout that is being passed out. Please take a few minutes to look over both tables on the sheet. On a separate piece of paper, please take 10 minutes to address the following questions (in point form):

Are these responses in line with your own perspectives and experiences? Is there anything surprising about these results? If so, which answers were

unexpected? Why? We will then discuss your answers as a group. Thank you and Wrap-Up 5 min Before we end the discussion, are there any other comments or points that anyone would like to discuss? I would like to thank you very much for your participation in this focus group. You have been very helpful to us and we appreciate your input.

International Pharmacy Graduate Focus Group Moderator’s Guide Introduction 5 min Welcome! I’d like to thank you all very much for coming to this discussion group today. My name is ____________. I am a researcher with R.A. Malatest & Associates Ltd, a Canadian research and evaluation company. Our purpose is to get your insights and understanding of the challenges and issues facing international pharmacy graduates in Canada. We are hearing from international pharmacy graduates and pharmacy owner/managers through a series of discussion groups across Canada. As many of you know, we have also done surveys with both international pharmacy graduates and pharmacy employers. This research is part of a larger research project called Moving Forward: Pharmacy Human Resources for the Future. The project is led by the Canadian Pharmacists Association and its partners. It is funded by the Government of Canada’s Foreign Credential Recognition program. First of all, I would like to take a minute to explain how we will proceed with this discussion:

Research Appendices


The focus group should take about one and a half to two hours.

This session is accredited by the Canadian Council for Continuing Education in Pharmacy (CCCEP), and by completing it you can earn 1.5 continuing education units. To obtain your Continuing Education certificate recognizing these CEUs you can complete the provided sign in sheet at the end of the session.

The session will be audio and/or video taped. The recording equipment is [equipment location]. We tape focus groups to make sure the results we present are accurate. [Indicate mirror and observers.]

Anything you say will remain confidential—that is, your name will not be associated with anything you say, and we will just use first names.

I’d like to point out that there are no right or wrong answers and that I am not looking for group agreement on each topic. We would like to hear a diversity of answers and perspectives.

So, if everyone is comfortable, we will now get started. Self-Intro 5 min Let’s start the discussion by going around the table and having everybody introduce themselves. Please tell us your name (first name only is sufficient), the year you came to Canada, and briefly about your experience working in your home country in community, hospital, or industry pharmacy practice. A. Coming to Canada 20 min I would like to hear about your experience in planning for a career as a pharmacist in Canada.

1. When you considered coming to Canada, what were your career plans or job expectations? [Probe: Did you expect to be working as a pharmacist in Canada?]

2. Before you settled in Canada, what sources of information, if any, did you use to help plan and prepare to work in

Canada? [Moderator to make a list on flip chart]

3. Which were the most useful? Why? Which were the least useful? Why?

4. What types of information did you lack that you would have liked to have had or that would have been helpful? Why would these have been helpful?

[Moderator to make a list on flip chart] B. Settlement and Licensure 30 min Now I would like to hear about your experiences since settling in Canada.

1. What were the reasons that you first settled where you did in Canada? [Probe: Did your career plans have any impact on where you first settled in Canada?]

2. Are you currently living/working where you first settled in Canada?

3. How many of you have tried to become licensed to practice as a pharmacist in Canada? How many have been

successful?

4. Individual Exercise: On your own, please write down on the paper provided the biggest problems or challenges you have faced in becoming licensed as a pharmacist in Canada. [Share responses with the rest of the group.] If some participants have not attempted to become licensed: Please write down the reasons you have not attempted to become licensed as a pharmacist in Canada. [Moderator to make lists on flip chart]

5. What, if anything, helped you to deal with or overcome these problems or challenges? What else would have helped you to overcome these problems or challenges?

[Moderator to make a list on flip chart]

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C. Bridging/ Support Programs 15 min 1. Have any of you taken a bridging or support program/course specifically to help you obtain your pharmacist license

and/or work as a pharmacist in Canada? If yes, why did you take the program or course? Did it meet your expectations? Why or why not? If no, why not?

D. Working in Canada 25 min 1. What are the biggest problems or challenges you have faced in getting pharmacy-related employment in Canada? For

example, this can include finding training positions, or obtaining employment as a licensed pharmacist. [Share responses with the rest of the group.]

[Moderator to make a list on flip chart] 2. a) What helped to address these issues? B) What could/would have helped to overcome these problems/issues? For those who are or have worked in pharmacy in Canada: 3. Since beginning to work in pharmacy in Canada, what were/are some of the issues, problems or challenges you have

faced? What has been the most difficult aspect of working in pharmacy in Canada? [Prompt: these can include anything from working with employers, co-workers or clients to the technical aspects of working in a pharmacy.[

[Moderator to make a list on flip chart] 4. a) What helped to address these issues? B) What could/would have helped to overcome these problems/issues? 5. Are you happy with your work situation? [Time permitting: Would you do it all over again? Have you changed your

opinion of what working as a pharmacist in Canada means?] E. Thank you and Wrap-Up 5 min Before we end the discussion, are there any other comments or points that anyone would like to discuss? I would like to thank you very much for your participation in this focus group. You have been very helpful to us and we appreciate your input.

Research Appendices


Template for Bridging / Support Program Fact Sheets

Name of School

Institution/organization

Name of Program/course

Location of program

Program Type

Type of Program

Purpose of Program

Target Clients?

Only available for pharmacists? (Y or N)

Only available for internationally educated? (Y or N)

Program Format

Full- or Part-time? (# hours per week)

Duration of Program (# weeks)

Unique configurations (e.g. links to practical training)

In-person or on-line?

Offered how many times per year? When?

# of seats available (presently)

# of enrolled students (presently)

Is there a wait list (Y or N)

Brief description of the program format

Appendix E: Template for Bridging/Support Program Fact Sheets

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Program Content

Brief overview of program/course subjects/modules

Program Entrance Requirements

Specify specific entrance requirements

IPG Assessment (pass/fail?, mandatory? Exemptible?)

Program Cost and Available Funding

Tuition costs

Other costs (books, etc. to be specified)

Funding available for students? If yes, specify what types.

Brief Description of the Program

Short Paragraph description of the program, including when it was started and why, if available.

How is the program funded?

Contact Information and How to Apply

How and When to Apply

Contact Information (contact name, address, telephone, fax, email, website)

Program Evaluation

Any performance measurement results that can be prepared?

Has the program been evaluated?

What are some of the key findings?

Research Appendices


ASSOCIATION OF DEANS OF PHARMACY OF CANADA(ADPC)

ASSOCIATION OF FACULTIES OF PHARMACY OF CANADA(AFPC)

CANADIAN ASSOCIATION OF CHAIN DRUG STORES (CACDS)

CANADIAN ASSOCIATION OF PHARMACY TECHNICIANS (CAPT)

CANADIAN PHARMACISTS ASSOCIATION (CPhA)

CANADIAN SOCIETY OF HOSPITAL PHARMACISTS (CSHP)

NATIONAL ASSOCIATION OF PHARMACY REGULATORY AUTHORITIES (NAPRA)

THE PHARMACY EXAMINING BOARD OF CANADA (PEBC)

OFFICE OF THE SECRETARIAT

1785 ALTA VISTA DRIVE, OTTAWA ON K1G 3Y6TEL.: 613-523-7877 • FAX: [email protected]

Funded by the Government of Canada’s Foreign Credential Recognition Program