The Experience of the HIRE IEHPs Initiative

1. Dr. Zubin Austin & Marie Rocchi
University of Toronto
Plenary II: The Experience of the
HIRE IEHPs Initiative

2. The HIRE-IEHP
Initiative
Zubin Austin PhD and Marie Rocchi MEd
University of Toronto
(on behalf of a cast of thousands)

3. HIRE IEHPs
Healthforce
Integration
Research and
Education
for
Internationally
Educated
Health
Professionals

4. Background
• Skills shortages in health professions as a media (then public policy)
problem in the 1990s – issues of access for patients
• Emergence of social justice/equity concerns regarding under-
utilization of well-educated immigrants
• Recognition of systemic barriers at the pre-licensure level
• Need to maintain public confidence in knowledge and skills of all
health practitioners
….a delicate and challenging balancing act

5. Background
• Development of pan-professional coalitions of regulators, educators,
employers, professional associations to align efforts related to both
skills shortages and “the problem” of IEHPs
• Emergence of bridging education programs to support social and
professional integration
• Development of institutions (e.g. CEHPEA (as it was then known))
• Interprofessional partnerships to align efforts in areas of common
interest (e.g. Orientation to the Canadian Healthcare System)
• General interest in ensuring as many IEHPs as possible could progress
to licensure with appropriate supports

6. How times change….
On the supply side:
- Post 2008-recession results in more health professionals working
longer than expected
- Increasing numbers of health professionals graduating within Canada
- Increasing numbers of Canadians who Studied Abroad (CSAs)
returning home
On the demand side:
- Evolving scope of practice of many professions shifts demand curve
- Increasing complexity of health care delivery emphasizes
interpersonal and communicative competency
- Risk mitigation around hiring practices

7. The development of the HIRE IEHPs initiative
• Evolved during a time of labour surplus in many professions
• Response to anecdotes regarding differential career trajectories of
IEHPs and Canadian graduates
• Issues remain with mal-distribution of healthcare workforce, despite
apparent labour surplus
• Increasing concerns expressed by regulators regarding risk mitigation
and the issue of institutional/cultural “fit”
• An opportunity for the Health Force Ontario Marketing and
Recruitment Agency (HFO-MRA) and University of Toronto (U of T) to
partner using complementary skills and resources to support
workplace integration

8. What was the problem we were trying to
solve?
• Getting a license is NOT the end of the story for most IEHPs
• Systemic barriers persist within workplaces, which may be beyond
the purview of the OFC or other agencies
• These barriers may result in chronic underemployment of IEHPs
• Some IEHPs expressed concerns related to cultural integration
outside large urban centres, despite the availability of good-quality
jobs
• Issue of “Canadian experience wanted” manifests in different ways
• Systems for supporting IEHPs which had evolved during a time of
skills shortage seemed uniquely ill-equipped to manage the reality of
a time of skills surpluses

9. Initial Research Findings
• Used an evidence-informed approach to development of curricular
tools/resources to support IEHPs and workplaces
• Objective was to develop a suite of online resources and supports to
address gaps and needs and identified by diverse stakeholders
• Partnership with HFO-MRA was crucial to not only understanding
dimensions of the post-licensure integration issues but to support
dissemination and uptake of resources

10. Initial Research Findings
Employers:
• Risk mitigation dominated hiring decisions: high-profile cases of
socio-cultural and linguistic misalignments negatively sensitized some
employers
• Workplace integration concerns dominated reasoning related to
hiring decisions, yet specifics of “fit” were frequently hard to explain
or define
• Skills surplus environment resulted in less emphasis on and lower
priority for IEHPs
• Employers expressed need for a clear “business case” and workplace
supports related to hiring IEHPs
• “A license simply means you’ve met some arbitrary minimum
competency requirement – we want and expect our staff to do better
than just minimum competency.”

11. Initial Research Findings
IEHPs:
• Systemic barriers to hiring are real, painful, and confusing
• Few supports available post-licensure
• Concerns about leaving larger urban centers
• Recognition that licensure doesn’t guarantee workplace fit, but
frustrated by lack of available resources/supports post-licensure
• Pattern of underemployment post-licensure and relegation to lower-
level jobs in the profession

12. Initial Research Findings
General:
• On-boarding of ANY new staff member is a difficult process: this is
not an IEHP or CSA issue alone
• Cultural fit (or “synchronicity”) is a dominant determinant of hiring
decisions and ultimately success in the workplace
• Minimum fluency requirements and licensure examinations are not
reliable predictors of workplace success
• “Better to have an unfilled vacant position than the wrong person for
the job”: increase in temporary or precarious professional
employment not simply limited to IEHPs or CSAs
• Diminishing public attention and no formal scrutiny of post licensure
issues

13. Initial Research Findings
Alternative Careers:
- Emerged as a key issue for both employers and IEHPs, both at the
pre- and post-licensure stage
- Traditional skills-matching approaches highly unsatisfactory; this is a
highly complex psychological adaptation process requiring individual
attention…and time
- Career decision making is not a linear or forward process;
pragmatism and pride constantly jockeying for supremacy
- Tension between desire for cost saving/efficiency to produce a self-
serve on-line repository of tools and the reality of the need for one-
to-one support and counselling

14. Where we are today
The HIRE IEHPs Initiative
- Funded by Health Canada and administered through an agreement
with the Province of Ontario
- Partnership with HFO-MRA and University of Toronto
- Multifactoral interventions designed to support integrations of IEHPs
in the Canadian workforce through diverse evidence-informed
strategies
- Three core on-line resources to be used by IEHPs, employers,
settlement agencies, employment counsellors/coaches…and anyone
else (including domestically educated health care professionals)

15. PReP
• Practice Readiness e-Learning Program
• Designed around existing University of Toronto curriculum focused
on communication skills, cultural competency, and management of
challenging clinical situations
• Use of diverse on-line learning strategies including self-assessment,
self-reflection, video-trigger, reading, clinical vignettes, personal
stories, etc.

16. WIN
• Workplace Integration Network
• Initially designed around findings of employer-based research related
to barriers and facilitators to hiring of IEHPs; evolved into suite of
generally applicable on-boarding resources with particular emphasis
on issue of culture, communication, and integration
• Use of diverse on-line learning strategies including video-trigger,
clinical/workplace vignettes, games, readings, etc.

17. ACP
• Alternative Careers Program
• Built around recognition that the process of “losing” one’s primary
professional identity is a complex, psychologically fraught process
• Grounded in vocational counselling theory related to decision
making, grief, loss, and adaptation
• Use of case studies and comparators to support self-identification in
new roles, while still providing support for skills-matching type
activities

18. Accessing HIRE IEHPs: www.hireiehps.com

19. Landing Page: www.hireiehps.com

20. Practice Readiness e-Learning Program (PReP):
Communication Matters• Series of 16 online courses geared towards IEHPs
• Video-based: vignettes, subject matter experts, narration
• Learning activities: self-reflections, quizzes, games (e.g. matching)
• Additional resources provided for each course
• Evaluation surveys embedded in courses
• Completion time: 30-60 minutes per course
• Courses focus on communication, workplace issues, and challenging
situations in Canadian healthcare context to support successful
workplace integration

21. PReP: Course Topics
Part 1: Foundations Part 2: Advanced Part 3: Workplace Matters
Course 1: Working in Teams Part 1
– Teamwork and the Patient
Experience
Course 6: Part 1: Palliative Care 2 –
Autonomy and Choice
Course 11: A Primer on Employment
Law for Employees
Course 2: Interpersonal Conflict
and Conflict Resolution
Course 6: Part 2: Palliative Care 3 – The
Healthcare Provider as Patient Advocate
Course 12: The Interview Process
Course 3: Diversity Course 7: The Aging Population
Course 13: Working in Teams Part 2 –
Collaboration in the Workplace
Course 4: Pandemic:
Communication in Stressful
Situations
Course 8: Pain – Communication and
the Patient Experience
Course 14: Error Disclosure and
Apology
Course 5: Palliative Care 1 –
Communication and the Patient
Experience
Course 9: Gender, Sexuality and Identity Course 15: The Feedback Process
The Bridge (Transition)
Course 10: Indigenous Peoples of
Canada: Stories and Experiences
Course 16: Workplace Culture and
Integration

22. Accessing PReP: www.hireiehps.com

23. PReP: Courses

24. PReP: Courses

25. Videos, Reflections, Quizzes

26. PReP and WIN: Log in to track progress

27. Workplace Integration Network (WIN)
• Series of 9 online courses for employers, human resource managers,
supervisors, and employees working with IEHPs
• Versatile use: independent learning, staff development, workshop format
• Video-based: vignettes, subject matter experts, narration
• Interactive quizzes/exercises, reflective questions, tools/templates, resources
• Evaluation surveys embedded in courses
• Completion time: 15-30 minutes per course
• Courses focus on practical topics to support hiring and successful integration
of IEHPs into the workplace
• Topics rated highest for potential end-users: cultural diversity in the workplace,
“plain language” communication, interviewing, legal rights and responsibilities

28. WIN: Course Topics
Courses Topics
Course 1 Building a Business Case for Hiring and Integrating IEHPs
Course 2 Understanding the IEHP Perspective
Course 3 International Academic and Professional Credentials
Course 4 Professional Regulatory Bodies
Course 5 Part 1 – Open Communication
Course 5 Part 2 – Developing an Inclusive Writing Style
Course 6 Part 1 – Creating a Positive Work Environment
Course 6 Part 2 – A Primer on Employment Law for Employers
Course 7 Diversity and Integration
Course 8 Working in Teams
Course 9 Workforce Health

29. Accessing WIN: www.hireiehps.com

30. WIN: Courses

31. Course View, Video-Based Courses

32. Quizzes, Reflections, Exercises

33. Accessing ACP: www.hireiehps.com

34. Alternative Careers Program (ACP)
• Series of modules and tools that allow IEHPs to explore alternative
career options outside of the regulated health profession in which
they were originally trained
• Goal to support IEHPs in obtaining gainful alternative careers and
successfully integrating into the Canadian workforce
• Self-directed by IEHP or guided by HFO Advisor or Counsellor
• Evidence-Informed Program
• Participatory program design
• Based on vocational psychology/career counselling literature and
instructional design principles

35. ACP: Key Literature Findings
• LIM Consulting Associates – research report recommendations included:1
• Creating a central repository of alternative career resources
• Developing a series of illustrative alternative career case studies
• Chen, C. P.
2
• Cross-Cultural Life-Career Development framework for career counselling with immigrants;
importance of self-concept, life-career integration, human agency, contextual awareness, and
resiliency
• Novak, L. & Chen, C. P.
3
• Described helping strategies for foreign-trained professionals to increase self-efficacy, provide local
knowledge, advocate, and promote acculturation
• Savickas, M. L.4
• Narrative constructivist approach to career counselling; construct career through small stories,
deconstruct, reconstruct, and co-construct future career with client
1
LIM Consulting Associates. (2013). Foreign qualification recognition and alternative careers: Report submitted to the best practices and thematic task team of the
foreign qualifications recognition working group. Retrieved from http://novascotia.ca/lae/RplLabourMobility/documents/AlternativeCareersResearchReport.pdf.
2
Chen, C. P. (2008). Career guidance with immigrants. In J. A. Athanasou & R. Van Esbroeck (Eds.), International handbook of career guidance (pp. 419–442). Toronto:
Springer Science. 3
Novak, L. & Chen, C. P. (2013). Career development of foreign trained immigrants from regulated professions. International Journal for Educational
and Vocational Guidance, 13(1), 5–24.
4
Savickas, M. L. (2011). New questions for vocational psychology: Premises, paradigms, and practices. Journal of Career
Assessment, 19, 251–258.

36. • 10 Integrated Virtual IEHP Cases – exploratory interactive online cases
• Demonstrate (through narrative) alternative career pathways and resources
• Elicit self-reflection around alternative career options and decision-making
• 6 Online Modules – wrap-around virtual cases and resources
• Evaluation surveys embedded in modules
• Certificates of completion available
• Completion time: 1-2 hours per module
• Database of Resources for Alternative Careers
• Includes self-assessment tools, existing resources on alternative careers,
career exploration websites, etc.
ACP: Career Options e-Resource

37. Landing Page, Modules

38. ACP: Virtual Cases at a Glance

39. Logging in to ACP

40. Book Layout, Resources, Certificates

41. Virtual IEHP Cases

42. Virtual IEHP Cases

43. ACP: Advisor and Staff Manual
• To support advisors, counsellors, and staff using ACP with IEHPs
• Includes descriptions of content, activity guide, reflective questions,
and tips for use with clients

44. Program Evaluation
• Online Course/Module Exit Surveys
• Satisfaction with content – value, utility, learning outcomes
• User experience – access, navigation, design/organization
• Demographic information – e.g. profession, length of time in Canada (IEHPs)
• ACP: Readiness to pursue alternative careers
• Follow-up survey, IEHP focus groups, key informant interviews
• Pilot testing
• Ongoing feedback from Health Force Ontario and end-users
• Continuous improvement based on evaluation feedback

45. Current State
• PReP: 12 courses available
• WIN: 6 courses available
• ACP: All modules available
• Coming Soon…
PReP WIN
Working in Teams Part 2:
Collaboration in the Workplace
Building a Business Case for Hiring
and Integrating IEHPs
The Interview Process Understanding the IEHP Perspective
Error Disclosure and Apology Open Communication
The Feedback Process Creating a Positive Work Environment
Working in Teams

46. HIRE IEHPs: Using the Site
• Online platform allows
access to PReP, WIN, and
ACP
• Open access
• Create an account
(username/password) to
track progress and
complete surveys in
PReP and WIN: optional
• Account must be created
for ACP

47. Conclusion
• A suite of online resources has been developed for use by multiple
end users, including IEHPs, employers and advisors/counsellors
• Open access – all modules to be available by end of March 2017

48. 2017 Perspectives Symposium
March 2, 2017
#Perspectives2017