The aim of the IEP Program was to create the educational tools and infrastructure needed to sustain a program supporting internationally trained Physiotherapists applying for licensure in BC. Consideration was given to developing a program that included the necessary curriculum, resources, mentorship and practice opportunities to assist IEPs in their preparation for the exams and entering the Canadian workforce. As many resources as possible were made available on-line to serve the needs of IEPs from clinical practice sites distant from Vancouver. Evaluation was built into the program to inform continuing program improvements and the development of additional program initiatives. This has resulted in the Program attracting greater numbers of IEPs than projected, and providing the flexibility to support and accommodate these greater numbers. Projections identified the capacity to support and accommodate 8 IEPs per year in the practical and 16 in the written, and over the first 4 years of the program (2008–2011), 124 IEPs have participated. The program now recovers its expenses through charging the IEPs, and although participation has declined relative to the funded program, enrolment has been sufficient to cover costs. Using a framework to build the modules, gaining regular feedback and, making the necessary changes to develop an internationally educated health professional program has proven highly successful. Only 24 health professionals (19%) who entered the program were unable to succeed in national examinations and join the Canadian physiotherapy workforce. However, these professionals may retake the examination and enter the workforce in the future. The long-term data regarding entry of IEPs into practice indicates that at least 69 IEPs, who completed the IEP Program, entered the Canadian Physiotherapy workforce, with 34 of these working in the public sector.
The IEPs who participated appear to be representative of the population of Canadian immigrants; in the Canadian general populace the ratio of European to Asian immigrants is changing over time. In our population 58% of students came from the UK in 2009 and 12% in 2011, versus 10% of students from India in 2009 and 40% in 2011. The top four countries for physiotherapist immigrants practicing in Canada to have received their basic physiotherapy education, from 2007 to 2009, were UK (21%), India (15%), USA (10%) and Australia (8%) . The IEP program had fewer applicants from the U.S.A. and more from Australia; this could be explained by British Columbia having a lower U.S.A. and higher immigration rate from Asia and the Pacific than other provinces (Canadian average = 9% from USA, 25% from Asia and the Pacific; B.C. 6% and 59% respectively). Training, examination methods, healthcare context, and physiotherapist roles in the UK and Australia align more closely with Canadian standards than those from other countries (i.e. India and the Philippines); it is possible that Physiotherapists from countries with different academic procedures seek more opportunities to receive additional support for the exam preparation.
The primary objective of this program was to increase the pass rate of internationally trained Physiotherapists taking the PCE. The success of the program in increasing the pass rate of IEPs taking the PCE has been achieved with international graduates who took the program having a 28% greater possibility of passing the written section than their counterparts who did not take the program. The results for the clinical exam are even more impressive with the IEP program students having a 39% increase in risk of passing. A greater percentage of Canadian-educated candidates for the PCE continue to pass both elements of the PCE but the gap is closing, particularly in the clinical component. The program was developed partially due to the observation that in 2005 less than 50% of PCE attempts translated into passes in IEPs ; the students who participate in the program now far surpass this with more than 65% gaining a pass. Trends in IEP successes on the QE also indicate higher pass rates over time, suggesting a positive impact of the new initiatives including the written workshops, additional resources (expanded exam bank, additional written exam practice, glossaries and self-study questions), mobile mentors, small group mentorship, and transitioning the written program to an on-line platform to promote access throughout BC, across Canada and internationally.
It may be expected that those who do not have English as their first language would have more difficulty with participating in the course and passing the exams, in particular, the written element. This appears to be false for the QE, the relative risk is 1.58 but the confidence interval is very wide, crossing 1 (equality) and is not significant. However, in the slightly larger number of people taking the PNE (n = 81), the relative risk demonstrates that those with English as their first language have a significant, 40% greater risk of passing the clinical element. The IEP success rate on the PNE indicates a slight decrease over time, when more candidates who did not have English as their first language participated.
Although the IEP program targets internationally trained Physiotherapists, this model could be transferred to other health professions given the identified need to support internationally trained health professionals transitioning into the Canadian workforce , and the similarity in processes related to the passing competency examinations prior to registration in these professions . Using program evaluation methodology, including the logic model, proved a successful approach for the development of a program that aimed to integrate internationally educated health professionals into clinical practice.
As this is a relatively new program, there are not sufficient numbers of IEPs who have participated to enable sub-analyses of the data and examination of particular elements of the program. Collecting more qualitative data will allow for more in-depth analysis of the IEPs integration into Canadian practice and the impacts on acculturation and socialization.