Provincial Regulatory Bodies Research Articles

Diversity gaps among practicing ophthalmologists in Canada: a landscape study

ObjectiveOutline geographic disparities in access to language-and gender-concordant ophthalmologic care in Canada. DesignCross-sectional. ParticipantsPracticing ophthalmologists in Canada (September 2023). MethodsData on ophthalmologists, including demographics, languages spoken, and practice locations, were collected from provincial regulatory body websites. Population data were extracted from the 2021 Statistics Canada Census. Ratio of ophthalmologists-to-potential patients and mean distances (absolute, population-weighted) to gender- and language-concordant care were calculated. The five most common languages spoken in the included provinces were analyzed. ResultsThere were 986 and 1338 ophthalmologists in the language and gender analysis, respectively. Few ophthalmologists spoke non-official languages in Saskatchewan, Manitoba, and Nova Scotia. In a population-weighted analysis, the distance to a language-concordant ophthalmologist were 4.55 times greater for Spanish speakers compared to their English counterparts. Cantonese speakers had the shortest distances to language-concordant care but were still had 40% greater distance than English speakers in the same regions. Despite French-speaking ophthalmologists being the most prevalent per 100 000 speakers, francophones outside Quebec endured distances over double that of anglophones to access language-concordant care. Females in Newfoundland and Saskatchewan faced the longest distances to access gender-concordant care. In Ontario, females may face 3 times the distance to gender-concordant ophthalmologists compared to males. Quebec approaches gender parity with a male-to-female ratio of 55:45. ConclusionsThe results highlight the disparities in accessibility to non-English ophthalmologic care and the underrepresentation of female ophthalmologists across Canada. These disparities underscore the need for targeted strategies to ensure that the ophthalmologic workforce mirrors the demographic of the population it serves.

Surgical Cancellations and Postponements by Surgeon and Patient Sex: A Retrospective Cohort Study in Alberta, Canada.

The objective of this work was to estimate the association between surgeon sex with surgical postponements or cancellations. Female surgeons receive lower hourly, per patient, and total compensation than their male colleagues. Bias in the decision to postpone or cancel surgical cases may contribute to compensation inequality, since this results in unpaid surgeon time. This retrospective cohort study used administrative health data to identify surgeries performed at four hospitals in Calgary, Alberta, Canada that were cancelled or postponed due to surgeon/operating room overbooking or to accommodate an emergency case between April 1, 2015, and March 31, 2020. Surgeries performed in dedicated operating or procedure rooms (e.g., bronchoscopy, cardiac surgery, etc.) were excluded. The exposure of interest was surgeon sex, identified by matching their name to the provincial regulatory body record of self-identified sex, which allowed for selection between female and male only during the time of this study. There were 214,832 eligible surgical cases, of which 1,481 and 2,473 were postponed or cancelled due to overbooking and to accommodate an emergency, respectively. After adjusting for surgical specialty, whether the procedure was a day case, and for patient sex, female surgeons were more likely to be cancelled or postponed to accommodate an emergency case compared to male surgeons (odds ratio [OR] 1.21, 95% confidence interval [CI] 1.05-1.38). There may be sex-bias in the decision about which surgical cases to postpone or cancel to accommodate emergency surgeries in our setting. This bias may contribute to compensation inequality in a fee-for-service setting.

Evaluating the impact of novel oncology drug coverage through patient assistance programs in British Columbia (BC), Canada.

13 Background: Despite a universal public healthcare system, Canadian oncology patients often enroll in patient assistance programs (PAPs) through drug manufacturers to access oncology drugs that are awaiting funding decisions by national and provincial regulatory bodies. Our multicenter study evaluated the pharmacoeconomic and clinical impact of PAPs for cancer patients in BC. Methods: Eligible patients were diagnosed with cancer and enrolled in a PAP for an oncology drug between January 1, 2016 - December 31, 2019 in 3 BC centres. Charts were reviewed for treatment details and survival data. We referenced median overall survival (mOS) or median progression-free survival (mPFS) data from phase III trials. mPFS data was used if mOS was unavailable or not statistically significant. For each drug indication, the hazard ratio from trial data was multiplied by the mOS or mPFS of our cohort to estimate the mOS or mPFS if the drug was not received. Life-years gained (LYG) was defined as the difference between the actual mOS or mPFS in our cohort and the estimated mOS or mPFS if the drug was not received. Mean OS was used if median OS was not reached by the cut-off date January 1, 2021. Quality-adjusted life years (QALY) and cost per drug were obtained from the Canadian Agency for Drugs and Technologies in Health (CADTH). QALY gained per drug was calculated as QALY multiplied by LYG. Assuming $100,000 Canadian dollars (CAD) for 1 QALY gained (based on prior studies), the economic value of QALY gained was calculated as $100,000 CAD multiplied by QALY gained per drug. Results: Our cohort consisted of 1025 patients that accessed 40 oncology drugs via PAP. By the cut-off date, 290 patients continued on treatment while 735 had stopped, most often due to disease progression (69%) or toxicity (14%). 74 patients then accessed another drug in their second exposure to PAP, and 5 patients accessed drugs in their third exposure to PAP. Median time from Health Canada approval to public funding was 2.04 years (IQR 1.53 – 2.34). QALY gained per drug ranged from 0.007-2.997 years for OS and 0.001-1.339 years for PFS. This translated to a total of 268.3 QALY gained in OS and 117.6 QALY gained in PFS. In the first exposure group, total economic value gained from PAP was $26,788,512 for those with OS benefits, $11,763,571 for those with PFS benefits, and total drug costs were $94,150,774. In the second exposure group, total economic value gained was $566,253 for those with OS benefits, $947,134 for those with PFS benefits, and total costs were $4,917,017. In the third exposure group, $44,754 total economic value was gained and total costs were $931,207. Conclusions: Nearly $100 million CAD of non-public funding was required to bridge gaps between regulatory approval and public funding. The economic value and QALY gained from PAPs are substantial. Future studies should focus on strategies to optimize the funding process for novel cancer therapies.

Regulating for-profit virtual care in Canada: Implications for medical profession regulators and policy-makers.

For-profit virtual medical care has been expanding rapidly in Canada, creating new societal and practical challenges requiring policy and regulatory reform. We mapped the current state of regulatory policy across 10 Canadian provinces by analyzing practice standards and guidelines for virtual care from medical profession regulators. Through a comparative framework, we assessed the extent to which virtual practice policies addressed issues around mobility and licensure, equitable access, privacy, complaints, and continuity of care. We also compared these regulatory documents to the model standards from the Canadian medical regulatory consortium and considered implications for practicing in for-profit virtual environments. We found considerable variation across provincial regulatory bodies, with most existing frameworks not adequately addressing equity, access, and practitioner competency and not providing flexible, nuanced, or risk-based approaches to virtual care provision. As we compared jurisdictions, we identified gaps and leading practices to inform recommendations for professional regulators and policy-makers.

Remediation Programs for Regulated Health Care Professionals: A Scoping Review.

Clinical competence is essential for providing safe, competent care and is regularly assessed to ensure health care practitioners maintain competence. When deficiencies in competence are identified, practitioners may undergo remediation. However, there is limited evidence regarding the effectiveness of remediation programs. The purpose of this review is to examine the purpose, format, and outcomes of remediation programs for regulated health care practitioners. All six stages of the scoping review process as recommended by Levac et al were undertaken. A search was conducted within MEDLINE, Embase, CINAHL, ERIC, gray literature databases, and websites of Canadian provincial regulatory bodies. Emails were sent to Registrars of Canadian regulatory bodies to supplement data gathered from their websites. A total of 14 programs were identified, primarily for physicians (n = 8). Reasons for remediation varied widely, with some programs identifying multiple reasons for referral such as deficiencies in recordkeeping (n = 7) and clinical skills (n = 6). Most programs (n = 9) were individualized to address specific deficiencies in competence. The process of remediation followed three stages: (1) assessment, (2) active remediation, and (3) reassessment. Most programs (n = 12) reported that remediation was effective in improving competence. Regulatory bodies should consider implementing individualized remediation programs to ensure that clinicians' deficiencies in competence are addressed effectively. Further research is indicated, using reliable and valid outcome measures to assess competence immediately after remediation programs and beyond.

Perceptions of Independent Pharmacist Prescribing among Health Authority- and Community-Based Pharmacists in Northern British Columbia.

Pharmacists across Canada have varying degrees of ability to prescribe medications depending on their jurisdiction of licensure. The purpose of this study was to the evaluate attitudes, beliefs, and perceptions of independent pharmacist prescribing among health authority- and community-based pharmacists. This prospective, cross-sectional online survey assessed the perceptions of independent pharmacist prescribing of health authority and community pharmacists practising in northern British Columbia (BC), which was defined as within the geographical boundaries of Northern Health. Responses were analysed using descriptive statistics and a regression analysis. There were 45 respondents to the survey: 22 community pharmacists and 23 health authority pharmacists. Both community and health authority pharmacists held positive perceptions of independent pharmacist prescribing and did not identify any barriers to incorporating independent pharmacist prescribing into their practice. Respondents were highly likely to apply for independent pharmacist prescribing authority, if available. Pharmacists in BC are currently not able to independently prescribe schedule I medications. The provincial regulatory body has proposed a framework for a Certified Pharmacist Prescriber designation, which if approved would allow pharmacists to prescribe in collaborative practice settings. This study provides some insight into the perception of pharmacists in northern BC in pursuing this designation, which may be valuable for planning purposes in case of adoption of the framework. These results are also likely applicable to other non-urban practice settings in Canada. Pharmacists in northern BC perceived independent pharmacist prescribing positively and a high proportion were likely to apply for this authority if it were permitted via legislation.

Take home injectable opioids for opioid use disorder during and after the COVID-19 Pandemic is in urgent need: a case study

BackgroundIn North America the opioid poisoning crisis currently faces the unprecedented challenges brought by the COVID-19 pandemic, further straining people and communities already facing structural and individual vulnerabilities. People with opioid use disorder (OUD) are facing unique challenges in response to COVID-19, such as not being able to adopt best practices (e.g., physical distancing) if they’re financially insecure or living in shelters (or homeless). They also have other medical conditions that make them more likely to be immunocompromised and at risk of developing COVID-19. In response to the COVID-19 public health emergency, national and provincial regulatory bodies introduced guidance and exemptions to mitigate the spread of the virus. Among them, clinical guidance for prescribers were issued to allow take home opioid medications for opioid agonist treatment (OAT). Take Home for injectable opioid agonist treatment (iOAT) is only considered within a restrictive regulatory structure, specific to the pandemic. Nevertheless, this risk mitigation guidance allowed carries, mostly daily dispensed, to a population that would not have access to it prior to the pandemic. In this case it is presented and discussed that if a carry was possible during the pandemic, then the carry could continue post COVID-19 to address a gap in our approach to individualize care for people with OUD receiving iOAT.Case presentationHere we present the first case of a patient in Canada with long-term OUD that received take home injectable diacetylmorphine to self-isolate in an approved site after being diagnosed with COVID-19 during a visit to the emergency room where he was diagnosed with cellulitis and admitted to receive antibiotics.ConclusionIn the present case we demonstrated that it is feasible to provide iOAT outside the community clinic with no apparent negative consequences. Improving upon and making permanent these recently introduced risk mitigating guidance during COVID-19, have the potential not just to protect during the pandemic, but also to address long-overdue barriers to access evidence-based care in addiction treatment.

Geographic availability to optometry services across Canada: mapping distribution, need and self-reported use

BackgroundThis research investigates the distribution of optometrists in Canada relative to population health needs and self-reported use of vision services.MethodsOptometrist locations were gathered from provincial regulatory bodies. Optometrist-to-population ratios (i.e. the number of providers per 10,000 people at the health region level) were then calculated. Utilization of vision care services was extracted from the Canadian Community Health Survey (CCHS) 2013–2014 question regarding self-reported contacts with optometrists or ophthalmologists. Data from the 2016 Statistics Canada census were used to create three population ‘need’ subgroups (65 years and over; low-income; and people aged 15 and over with less than a high school diploma). Cross-classification mapping compared optometrist distribution to self-reported use of vision care services in relation to need. Each variable was converted into three classes (i.e., low, moderate, and high) using a standard deviation (SD) classification scheme where ±0.5SD from the mean was considered as a cut-off. Three classes: low (< − 0.5SD), moderate (− 0.5 to 0.5SD), and high (> 0.5SD) were used for demonstrating distribution of each variable across health regions.ResultsA total of 5959 optometrists across ten Canadian provinces were included in this analysis. The nationwide distribution of optometrists is variable across Canada; they are predominantly concentrated in urban areas. The national mean ratio of optometrists was 1.70 optometrists per 10,000 people (range = 0.13 to 2.92). Out of 109 health regions (HRs), 26 were classified as low ratios, 51 HRs were classified as moderate ratios, and 32 HRs were high ratios. Thirty-five HRs were classified as low utilization, 39 HRs were classified as moderate, and 32 HRs as high utilization. HRs with a low optometrist ratio relative to eye care utilization and a high proportion of key sociodemographic characteristics (e.g. older age, low income) are located throughout Canada and identified with maps indicating areas of likely greater need for optometry services.ConclusionThis research provides a nationwide overview of vision care provided by optometrists identifying gaps in geographic availability relative to “supply” and “need” factors. This examination of variation in accessibility to optometric services will be useful to inform workforce planning and policies.

Adoption of NCLEX-RN for licensure in Canada: Faculty concerns and implications for nursing education.

This paper highlights questions about Canadian nurse regulators' adoption of the U.S.-based NCLEX-RN examination, effective 2015, as the only route to initial registered nurse licensure in all jurisdictions, excluding Quebec. The decision for this change was made by the Canadian Council of Registered Nurses Regulators (CCRNR), an umbrella association of CEO's of provincial regulatory bodies in collaboration with the National Council of State Boards of Nursing (NCSBN). Adoption and implementation of this new policy was accomplished by the Council of each provincial regulatory body. This change, representing the first international adoption of NCLEX-RN, was deemed successful by CCRNR and NCSBN.However, the Canadian Association of Schools of Nursing (CASN) described the decision as unilateral and unwise, questioning the applicability of NCLEX-RN in the Canadian context, citing significant French language translation issues and unacceptable pass rates.Both authors have had extensive academic nursing experience in U.S. and Canada. Both had many conversations with Canadian colleagues who described the impact on nursing education as disastrous. Most of our American colleagues knew nothing about this change, but once informed, expressed some concerns similar to those of their Canadian counterparts. We suggest that international adoption of a US-based examination for initial licensure merits wider discussion by nursing faculty here and abroad.

Oral cancer screening practices of Canadian dental hygienists.

This study investigates whether dental hygienists are routinely conducting oral cancer screenings (OCSs) as per their professional capability and responsibility. Factors that may mediate provision of OCSs, and ability to discuss sensitive topics with patients, are also examined. A pretested online questionnaire was sent via national and provincial regulatory bodies to target practicing registered dental hygienists across Canada. Analysis was conducted using statistical software. Results of 256 surveys were analysed. Sixty-four per cent of dental hygienists listed an OCS as part of their regular process of care. Except for the initial examination, respondents were significantly more likely to report being responsible for the OCS than the dentist, P<.001. On average, intraoral components are inspected at higher frequencies (96%) than extraoral components (73%). Confidence in OCS technique was high (70%). The majority felt prepared by their education to conduct OCSs (60%), but those with a bachelor's degree felt more prepared than those with a diploma, P=.005. The average time to conduct an OCS is 4.09minutes, with most agreeing there is sufficient time in an appointment (57%). Only 37% felt their education prepared them to discuss sensitive topics, level of education had no effect, P>.05. Only 43% of respondents felt confident in their human papillomavirus (HPV) knowledge and comfortable discussing HPV risk factors with patients. Dental hygienists in this study are regularly conducting OCSs; however, they lack comfort discussing sensitive topics such as transmission of oral HPV, and screenings may not be fully comprehensive.

Recent Regulatory and Legislative Developments of Interest to Oil and Gas Lawyers

Surveyed herein are the recent regulatory and legislative developments of significance to the oil and gas industry. This article canvasses decisions of the courts, bulletins from national and provincial regulatory bodies, and legislative initiatives to provide a comprehensive update for the oil and gas lawyer.

A Complicated Welcome: Social Workers Navigate Policy, Organizational Contexts and Socio-Cultural Dynamics Following Migration to Canada

Canada prides itself on a reputation of being a welcoming and inclusive country, promoting a collective pride in upholding a multicultural mosaic wherein a rich diversity of ethnicities, cultures and religions co-exist. A priority of the Canadian federal government is the attraction and retention of skilled foreign workers into the labour market, and social workers have been targeted for this government initiative. Alluring though this ideal picture may be, the experiences of forty-four migrant social workers who undertook their social work education outside Canada and currently practice social work in Canada suggest significant barriers on the levels of policy, organizational context and socio-cultural dynamics. On the level of policy, participants navigated processes for immigration, recognition of foreign credentials, and licensure with the provincial regulatory body. On the level of organizational context, participants faced a range of challenges in securing social work employment. On the level of socio-cultural dynamics, participants detail the many interactive subtleties experienced as they sought to ‘fit in’ in order to connect with their new colleagues and communities. Analysis draws on the concepts of institutional and embodied cultural capital as the means though which social status is differentially available for these migrant social workers, based on the ascribed value of their citizenship characteristics, educational preparation, and practice experience. These forms of capital facilitate mobility by enabling access to opportunities and the tools to acquire status and entry to a particular class, that of the social work practitioner in Canada.

Professional self-regulation: learning from the disciplinary process

Medical regulatory colleges have a mandate to protect and promote the health and safety of the public by regulating the practice of medicine by physicians. In Canada, provincial colleges of physicians and surgeons fulfill this mandate through activities related to a) the registration of physicians to practice, b) the regulation of how physicians practice (either proactive or reactive regulatory activities), and c) remediation of physicians where specific deficiencies are identified and where remediation is appropriate. Throughout most of the 150-year history of selfregulation of the medical profession in Canada, this role has been performed primarily by reactive regulation, i.e., disciplining physicians who have been found to be practicing in a manner that members of the profession would consider to be dishonourable, disgraceful, or unprofessional. As important as remediation may be, the disciplinary process remains a key means of maintaining the public trust in the profession. This is reactive regulation, as it results from a specific complaint, inquiry, or report to the college about a physician’s behaviour or performance. It is important to emphasize that most colleges have remediation programs that manage clinical practice deficiencies identified during the complaint process. Disciplinary procedures are invoked only when major unprofessional practices are found. By law, the college’s disciplinary proceedings and outcomes are transparent to the public. Disciplinary findings result from a formal adversarial legal process after an extensive investigation of the merits of the allegations. Formal charges are filed, and the physician involved is allowed to mount a thorough defense to the allegations. Although individual disciplinary findings are published by each provincial regulatory body, the report presented by Alam et al. in this issue of the Journal is the first systematic evaluation of disciplinary findings against anesthesiologists in Canada. The report follows the publication of their data on all disciplined physicians in Canada from 2000-2009. The authors conclude that publication of the causes of disciplinary actions may result in ‘‘interventions aimed at educating physicians around standard of care’’ and prevent such problems. Whether education can prevent such serious lapses of professionalism remains speculative at best, but their data give us the first specialty-specific, national perspective on this important issue. Their first contribution is to compare the scope of the problem for anesthesiologists with that for all physicians in Canada. They emphasize that there were 721 disciplinary findings against physicians of all specialties in Canada from 2000-2011, whereas only 11 findings were against anesthesiologists. This frequency represents disproportionately fewer anesthesiologists than many other specialties. This result differs from the report from California’s State Medical Board where anesthesiologists were overrepresented among disciplined physicians. Complaints that reach the Discipline Committee represent only 2-3% of the total number of patient complaints about physicians. This number probably The author is a member of Council of the College of Physicians and Surgeons of Ontario and has no other competing interests to declare.

Exploring the acquisition of entry-to-practice competencies by second-degree nursing students during a preceptorship experience

Nursing programs across Canada have begun to implement at an unprecedented rate second-degree nursing programs in response to consumer demands and a nursing shortage. While these types of programs are enjoying considerable popularity among prospective students and employers, it is imperative that nursing programs assess their graduates' ability to meet Registered Nursing entry-to-practice competencies (ETCs). This study sought to determine if second-degree undergraduate nursing students achieved the entry-to-practice competencies established by the provincial regulatory body for registered nurses of Alberta, Canada. The study took place in southern Alberta, Canada as the first cohort of second-degree undergraduate nursing students were completing the final practice course for the program. In this exploratory study, quantitative and qualitative data generation approaches were used. Quantitative data were collected using the nursing program's standardized Clinical Evaluation Tool which is mapped to the 119 ETCs established by the regulatory body. Qualitative data were generated by conducting focus group interviews with students, faculty advisors, and preceptors. A convenience sample consisting of both male and female students (n=14) submitted their mid-term and final clinical evaluations for inclusion in the dataset. Thirteen preceptors submitted mid-term and final clinical evaluations. Three students, three faculty advisors, and two preceptors participated in focus group interviews. At mid-term, statistically significant differences were noted on 31% of the indicators within the clinical evaluation tool between students and preceptors with preceptors consistently ranking students higher than the students' ratings of their performance. Student and preceptor ratings of students' clinical performance were more consistent on the final evaluation. However, where there were differences, preceptors rated students higher than student ratings. Qualitative data analysis suggests that the concept of competence is complex and multifaceted and understood differently by students, preceptors, and advisors. The findings of this study suggest that there is ambiguity among second-degree students, preceptors and faculty advisors surrounding the concept of competence. In order to develop an understanding of competence, nursing program administrators must encourage faculty advisors, preceptors and students to engage in a discussion at the outset of the preceptored practice experience in regard to what is meant by competence within various practice setting. Further, we suggest nursing programs in collaboration with their clinical partners and re-examine their practice evaluation tools to determine the degree to which they are sensitive to the clinical practice context.

Training graduate students to be clinical supervisors: A survey of Canadian professional psychology programmes.

Recognising the need for training in clinical supervision, the Canadian Psychological Association (CPA) requires that accredited professional psychology programmes offer graduate students training in supervision. To fill a gap in the existing supervision literature, we surveyed training directors (or designates) of CPA accredited clinical and counselling programmes to understand how this training standard is currently being met in the area of clinical supervision. Responses were obtained from 20 of 28 programmes (7 1 .4% response rate). Approximately 50% of respondents indicated that their programmes required some coursework related to clinical supervision, with wide variability, however, in the number of hours of coursework provided to students (range 3 to 39). Most courses included lectures and group discussion, but also often provided students with practical experience in clinical supervision provision. Only 25% of programmes required a practicum in which students gained experience in clinically supervising other students, although an additional 40% of programmes offered an elective practicum in which students gained some training in clinical supervision. Most programmes (-71%) identified strategies for improving training in clinical supervision (e.g., improving course work, requiring practical experience), but also identified challenges to offering clinical supervision training (e.g., availability of skilled supervisors, insufficient time to devote to supervision, student competency). Based on the findings, we offer some recommendations for how training in clinical supervision could be improved in Canadian professional psychology programmes as well as describe some important directions for future research in this area. Keywords: clinical supervision training, Canadian professional psychology programmes, survey Clinical supervision in psychology is recognised as a multifaceted task that requires specific knowledge and skills to both train the supervisee and monitor the supervisee's practise (Falender et al., 2004). That is, clinical supervisors need to provide training so supervisees enhance their skills. Supervisors are also ethically and legally responsible for the actions of supervisees and for preventing harm that may come from an incompetent or impaired supervisee (Campbell, 2006). Illustrating the importance given to clinical supervision, statistics provided by the Canadian Psychological Association (CPA) reveal that most students in 2006/2007 obtained over 1550 hours of supervised clinical experience prior to the predoctoral internship (CPA, 2009a). Additional supervised clinical hours are also obtained during the one year predoctoral internship (CPA, 2002), and many provincial regulatory bodies have postdegree clinical supervision requirements (Council of Provincial Associations of Psychology Database, 2005). Review of the literature shows that, while not all research finds that clinical supervision results in better patient care (e.g., Steingelber, Patterson, Cliffe, & LeGoullon, 1984), there is literature, albeit with some design limitations, that can be used to support the emphasis placed on clinical supervision. As an example, recent findings suggest that clinical supervision may assist therapists in managing the working alliance with clients and result in better client outcomes (Bambling, King, Raue, Schweitzer, & Lambert, 2006). Clients treated for depression, for example, rated the working alliance with their therapist as stronger when their therapist received clinical supervision compared to when their therapist did not (Bambling et al., 2006). In the same study, it was concluded that clients also showed greater improvement in depression when seen by supervised as compared to nonsupervised therapists. The findings from this study, however, are also open to alternative interpretations given design limitations. All supervised therapists had a pretreatment meeting with their supervisors that focused on alliance management principles; it is possible that it was this pretreatment meeting rather than ongoing clinical supervision that resulted in the differences between supervised and nonsupervised therapist. …

Personality Assessment Training: View From a Licensing Board

The literature contains numerous surveys about assessment training at the level of both doctoral programs and internships. There is minimal information about how such training is assessed by state and provincial regulatory bodies. In this article, we describe the process used by one state licensing board to assess a licensure candidate's transcript, conduct an oral examination, and potentially recommend remediation when the candidate is found to be deficient in specified skills. Our focus in this article is on the application of this evaluation process to personality assessment, although we also examined other areas of practice in a comparable manner.

Collaborative practice in health systems change: the Nova Scotia experience with the Strengthening Primary Care Initiative.

Recently attention has been focussed on the significance of primary care to the Canadian healthcare system. Nova Scotia. Like other provinces, is seeking ways to improve the healthcare that it provides within a financially constrained publicly funded system. The Strengthening Primary Care Initiative in Nova Scotia (SPCI) was a primary care demonstration project to evaluate specific goals related to primary care. Although the provincial government conceived the SPCI, the approach to its planning and implementation was participatory and consultative. Funded through the federal Health Transition Fund (HTF) (Health Canada 2002) and the government of Nova Scotia, the SPCI involved changes in four communities over a three-year period (2000-2002). These changes included the introduction of a primary healthcare nurse practitioner in collaborative practice with one or more family physicians; remuneration of the family physician(s) with methods other than a solely fee-for-service (FFS) arrangement; and the introduction and utilization of a computerized patient medical record. The SPCI was committed to a consultative process with stakeholders, and this gave rise to several challenges. Initially there was disagreement on the requirement for nurse practitioners at each of the demonstration sites. The Minister of Health confirmed that a nurse practitioner was a required component at each demonstration site. Differences in perspectives on the role of allied health professionals in the SPCI were encountered, and the significance of the role pharmacists have in primary care was not fully appreciated until after the SPCI had started. At the time the SPCI began there was no legislation for nurse practitioners in Nova Scotia; therefore, an approval mechanism for nurse practitioner practice was authorized through the provincial regulatory bodies for nursing and medicine. Malpractice and liability issues, particularly on the part of providers who had never worked with nurse practitioners before, were an initial concern. Recruitment of nurse practitioners into the three rural sites mirrored the difficulties with recruitment of healthcare providers encountered in other parts of rural Canada. The authors discuss their perspectives on the challenges related to interdisciplinary collaboration in health systems change that were encountered during the planning and implementation of the SPCI. Although nurse practitioner Legislation has existed in Ontario and Newfoundland and Labrador for several years, many provinces are grappling with the challenges associated with the introduction of nurse practitioners and collaborative practice. This paper conveys the experience of one province and will be of interest to administrators, educators and practitioners elsewhere in Canada who are engaged in primary healthcare renewal.

Nosocomial transmission of bloodborne viruses from infected health care workers to patients.

1Departments of Pathology and Laboratory Medicine, Medicine, and Microbiology and Infectious Diseases, University of Calgary, Calgary, Alberta; 2Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia Correspondence: Dr John Conly, Departments of Pathology and Laboratory Medicine, Medicine, and Microbiology and Infectious Diseases, Room 930, 9th Floor, North Tower, 1403 29th Street Northwest, Calgary, Alberta T2N 2T9. Telephone 403-944-8222, fax 403-944-1095, e-mail jconly@ucalgary.ca and Dr Lynn Johnston, Department of Medicine, Room 5014 ACC, Queen Elizabeth II Health Sciences Centre, 1278 Tower Road, Halifax, Nova Scotia B3H 2Y9. Telephone 902-473-5553, fax 902-473-7394, e-mail ljohnsto@dal.ca T risks to health care workers (HCWs) of occupationallyacquired infection with hepatitis B virus (HBV), human immunodeficiency virus (HIV) and, to a lesser extent, hepatitis C virus (HCV) have been reasonably well quantified (1). Evidence from the HIV and HBV experience suggests that the risk of infection is increased where the level of viremia is high, as manifested by high HIV viral load or the presence of hepatitis B e antigen (HbeAg) (1). It has also been recognized that patients may acquire one of these viruses following significant exposure to the blood of an infected HCW (2-4). While the magnitude of this risk to patients is considerably less than that to HCWs, the 1990 report by the Centers for Disease Control and Prevention (CDC) that a Florida dentist had transmitted HIV to patients in the course of dental care triggered widespread public concern about the risk of infection from HCWs. In 1991 CDC published recommendations for preventing HIV and HBV transmission to patients, which included the recommendation that HCWs who are infected with HIV or HBV (and HbeAg positive, a marker of higher infectivity) should not perform exposure-prone procedures unless they have sought counsel from an expert review panel (5). In 1998, Health Canada published guidelines for the management of HCWs infected with HBV, HCV, and/or HIV (6). Both these documents generated controversy at the time of their publication. Since that time, however, several provincial regulatory bodies have formed committees to advise physicians infected with these bloodborne pathogens (BBPs) regarding their practice. This article reviews what we know about the transmission of HBV, HCV and HIV from infected HCWs to patients in medical and dental settings.

The codes of ethics of the Canadian Psychological Association and the Canadian Medical Association: Ethical orientation and functional grammar analysis.

Abstract The Canadian Code of Ethics for Psychologists (Canadian Psychological Association, CPA, 2000) has been the subject of several recent investigations. This work has focused, for example, on the validity of its hierarchical organization of ethical principles. In the present research, we subjected the code to both a content and a functional grammar analysis. Our content analysis was aimed at determining the theoretical ethical orientation (i.e., deontological, teleological or caring) of each statement in the document, while the functional grammar analysis provided information about implicit messages embedded within the code. We contrasted the results of our analysis with those of previous work on the code of ethics adopted by the Canadian Medical Association (CMA). We concluded that, compared to CMA's code, the CPA document has greater educational value, is less authoritarian, provides a clear rationale for ethical behaviour, and is more empowering to the decision-maker. We argue that the results of our functional grammar and content analyses have implications for future attempts to improve ethics codes for psychology and other professions. Many organizations and most national professional associations have adopted codes of ethics. Such documents serve an educational function (e.g., O'Neill, 1998) and communicate important expectations to the membership of these organizations. Codes also serve to facilitate a profession's ability to self-regulate. They may also function as a means by which members can question their own personal values as they relate to their professional role (Meyer, 1987). Externally, codes of ethics assure the public, clients, and other stakeholders that members of a profession are competent, have a high level of integrity, and are able to enforce high moral standards (Pettifor, 1996). Codes of ethics also help professionals commit publicly and explicitly to their association's values, norms, beliefs, and philosophy and make them accountable (Dunbar, 1998; Pettifor, 1996). The Canadian Code of Ethics for Psychologists (Canadian Psychological Association, 1986, 2000) was designed to incorporate the collective wisdom of Canadian psychologists (Sinclair, Poisner, GilmourBarrett, & Randall, 1987). Sinclair et al. (1987) described the methodology that was used in the code's development. Briefly, the process involved the creation of 37 vignettes describing hypothetical ethical dilemmas. The dilemmas related to the ethical principles that were articulated in the 1977 edition of the code adopted by the American Psychological Association (APA, 1977). They also involved conflicts between ethical principles as well as psychological practice issues and situations involving innovative but untested approaches. Sinclair et al. formulated questions to elicit self-accepted ethical principles. They asked 400 Canadian psychologists to each respond to a series of questions about a portion of the vignettes. One hundred and twenty-five agreed to participate but only 59 responses were received. The researchers submitted these responses to a content analysis that focused on the reasons provided for the courses of action selected by the respondents. They organized the relevant statements into categories that reflected superordinate ethical principles. The resulting document consisted of four fundamental ethical principles (Respect for the Dignity of Persons, Responsible Caring, Integrity in Relationships, and Responsibility to Society). A consultative process with provincial regulatory bodies supported the validity of the document. Although the code has since undergone revisions, it still is based largely on the original document and its four fundamental ethical principles (CPA, 2000). The CPA (1986, 2000) code has received plenty of praise for its coherence, organization, and unique features (e.g., Booth, 1998; Dixon, 1998; Hadjistavropoulos & Malloy, 2000; Sinclair, 1998; Wassenaar, 1998); however, empirical research (e. …

A philosophical value analysis of the Canadian Code of Ethics for Psychologists.

Abstract The purpose of this paper was to explore, philosophically, the rationale for the ranking of the principles of the Canadian Psychologists' code of ethics. While this ranking has received some empirical support, it has yet to be grounded in theory. In order to overcome this conceptual deficiency, Hodgkinson's (1996) Value Paradigm was used as a critical framework for validating the hierarchical structure of the principles of the code. The analysis revealed general acceptance for the ranking. As a result, the code has gained not only the needed theoretical grounding for comprehensive support (i.e., theoretical and empirical) but also a more complete understanding of its content and axiological rationale.The Canadian Code of Ethics for Psychologists was developed to reflect the collective wisdom of Canadian Psychologists (Sinclair, Poizner, Gilmour-Barrett & Randall, 1987). Sinclair et al. (1987) describe the methodology that was followed to develop the Canadian code. Specifically, 37 hypothetical ethical dilemmas representing the applied, teaching, and research functions of psychologists were prepared. These vignettes reflected all principles that were covered by the 1977 code of ethics of the American Psychological Association (APA, 1977), as well as conflicts between ethical principles, current areas and issues in psychological practice and situations that involved innovative, but untested, approaches and techniques. Each vignette was followed by six questions that were designed to elicit self-accepted ethical principles (e.g., What is your choice of action? Why?, What alternative choice(s) of action(s) did you consider? Why did you choose them?). Four hundred Canadian Psychologists were asked to participate in the study and the 125 who agreed were sent two or four hypothetical dilemmas. The responses of the 59 persons who replied underwent a content analysis that focussed on the reasons provided for the selection of a course of action. The statements were then organized into groups until each group seemed consistent with a superordinate principle.The resulting document had four principles (Respect for the Dignity of Persons; Responsible Caring; Integrity in Relationships; and Responsibility to Society) each of which was accompanied by relevant values statements and standards. The principles were organized in order of importance in order to facilitate decision making in situations where conflict between principles exists. It appears, from the description of the process (Sinclair et al., 1987), that this hierarchical organization was based on survey participants' responses about situations in which the principles were in conflict. The standards were added to the principles largely based on pre-existing guidelines and reviews of the literature. Finally, the document underwent a consultative process (e.g., copies were sent to provincial regulatory bodies for feedback) that confirmed the principles and their hierarchical organization. The current code of the Canadian Psychological Association (CPA, 1991) reflects the original document with very minor revisions.The CPA code is now used widely and compares very favorably to codes adopted by other professional groups (Hadjistavropoulos, 1996). Of particular practical usefulness are the seven decision-making steps that are recommended by the code for situations in which ethical dilemmas are encountered. These are as follows: a) identification of ethically relevant issues and practices; b) development of alternative courses of action; c) analysis of short-term, ongoing, and long-term risks and benefits of each course of action; d) choice of course of action after conscientious application of existing, principles, values and standards; e) action, with a commitment to assume responsibility for the consequences of the action; f) evaluation of the results of the action; and g) assumption of responsibility for consequences of action, including correction of negative consequences, if any, or re-engaging in the decision making process if the ethical issue is not resolved. …