Presented at the 2006 CLEAR Annual Conference1

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Globalization and Labour Mobility
Jurisdictional Cooperation
Expect the Unexpected Are We Clearly Prepared?

• Alexandria, VA September, 15 2006
• Ordre des orthophonistes et audiologistes du
  Québec (OOAQ) (professional order of Québec
  speech-language pathologists and audiologists)

Council on Licensure, Enforcement and Regulation
2006 Annual Conference
Alexandria, Virginia
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• Speakers
• Louis Beaulieu, President and Director General,
• Ordre des orthophonistes et audiologistes du
  Québec
• Huguette Bernard, retired Professor,
• Université de Montréal, Québec
• Moderator
• André Gariépy, Director General,
• Québec Interprofessional Council

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Organization of the presentation

• 1 Legal, political, professional and
  organizational issues facing the OOAQ, which is a
  regulator
• 3 Challenges and winning conditions pertaining to
  the establishment of such an exam bearing in mind
  cooperation, better harmonization of standards
  between jurisdictions, the transfer of acquired
  expertise and cost efficiency

• 2 Conceptual and methodological elements linked
  to the development of an Education Equivalence
  Recognition Exam (EERE)
• 4 Questions and discussions with participants

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Legal, political, professional and organizational
issuesLegal and regulatory obligations

• Legal issues
• Professional Code (Act)
• The Board of the OOAQ must,
• by regulation, prescribe standards
• for equivalence

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Legal, political, professional and organizational
issue Regulatory obligations

• Two ways of proceeding
• Diploma equivalence
• Training equivalence
• (substantially equivalency)

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Legal, political, professional and organizational
issue Regulatory obligations

• Diploma equivalence
• Recognition by the Board of a professional order
  that a diploma issued by an educational
  institution located outside Québec certifies that
  a candidates level of knowledge and skills is
  equivalent to the level of a diploma giving
  access to the permit.

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Legal, political, professional and organizational
issues Regulatory obligations

• Training equivalence (substantially
  equivalency) 
• by regulation recognition by the Board that a
  candidates training has enabled him to attain a
  level of knowledge and skills equivalent to the
  level that may be attained by the holder of a
  diploma giving access to the permit.

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Legal, political, professional and organizational
issue Regulatory obligations

• Recognition of acquired knowledge
• A minimum of five years of relevant work
  experience in the speech-language pathology field
• Five factors to be considered
• (1) type and years of experience
• (2) type of courses taken and course content
• (3) clinical practicum completed
• (4) total years of education and
• (5) the possession by the candidate of one or
  more diplomas issued in Québec or elsewhere.

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General process objectives

• Ensure public protection
• Meet one of the OOAQs responsibilities in terms
  of admission to the practice
• Recognize masters degree level competence
  (graduate degree)
• Develop an efficient and secure approach focusing
  on quality
• Ensure a fair process for qualified candidates
  wishing to engage in the profession

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Legal, political, professional and organizational
issues Regulatory obligations

• How can we do so fairly in order to ensure
  competency and the protection of the public?
• Through an exam that measures competency instead
  of knowledge
• (the Act empowers the professional body to do
  so)

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Legal, political, professional and organizational
issues Regulatory obligations

• Political issues
• For Québec institutions, other regulators,
  employers and the public
• - Guarantee the competence of candidates who
  passed the exam.
• From the standpoint of labour mobility agreements
• Valuable approach
• Thorough process
• TO CONCLUDE Recognition by other jurisdictions

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Legal, political, professional and organizational
issues Regulatory obligations

• Political issues
• Within the practice
• project understanding (information)
• project acceptance
• Collaboration.
• For candidates
• fair and efficient process
• recognition of skill profiles (levels)
• avoid disputes.
• French language proficiency (spoken and written
  at the candidates discretion)

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Legal, political, professional and organizational
issues Regulatory obligations

• Professional issues
• Develop an exam that will truly ensure public
  protection.
• Design the entire corpus of knowledge and skills
  required for professional practice in order to
  measure them.

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Legal, political, professional and organizational
issues Regulatory obligations

• Professional issues
• Adopt an approach that takes into account the
  candidates acquired knowledge and experience
  with respect to engaging in the profession.
• Measure the numerous skills bearing in mind all
  of the relevant dimensions
• Knowledge
• know-how
• personal skills

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Legal, political, professional and organizational
issues Regulatory obligations

• Professional issues
• Measure competence and identify problems, if
  applicable.
• Be able to make specific recommendations to
  candidates.
• Be fair Require neither more nor less.

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Legal, political, professional and organizational
issues Regulatory obligations

• Organizational issues
• Establish a clear, indisputable process.
• Regularly elaborate a new exam.
• Funding and enduring nature.

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(3) Conceptual and methodological elements
linked to the development of the Education
Equivalence Recognition Exam (EERE)
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The project is funded by the

• Ministère de lImmigration
• et des Communautés culturelles
• du Québec
• Volunteer work

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Research team

• Louis Beaulieu, President and Director General,
  Ordre des orthophonistes et audiologistes du
  Québec (OOAQ)
• Huguette Bernard, Associate Professor,
• Faculty of Education, Université de Montréal
• Michèle Bergeron, speech-language pathologist,
• Full Professor, Speech-Language Pathology and
  Audiology School, Université de Montréal
• Carmen Phénix, speech-language pathologist,
• Chair of the OOAQs registration committee
• Fréderic Lapointe, doctoral student,
• Faculty of Education, Université de Montréal
• Joseph NKuba, doctoral student,
• Faculty of Education, Université de Montréal

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Conceptual and methodological elements linked to
the development of the Education Equivalence
Recognition Exam (EERE)

• Issues and considerations
• Choice of orientation make the right choices.
• Develop a professional practice framework.
• Choose the instrumentation.
• Develop the exam.
• Develop the correction methodology.
• Consider validation.
• Elaborate the success profile.
• Communicate the results.
• Stick to the timetable.

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1. Choice of orientation Objectives
Competencies

• Cognitive objectives (taxonomy - Bloom, 1956)
• 6. Evaluation
• 5. Synthesis
• 4. Analysis
• 3. Application
• 2. Comprehension
• 1. Knowledge

Complexity
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1.Choice of orientation Objectives
Competencies

• Competencies
• Mobilize individual cognitive resources and
  experience in order to deal with a situation
  (analyze - recommend - intervene).
• Consider an array of problems in different
  situations in respect of a broad range of
  patients (clients).
• The more complex a task is the more dimensions
  there are to evaluate.
• A person can be learned but not competent.
•  On peut être savant mais pas compétent 
• (Le Boterf, 1999 2000)

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1.Choice of orientation Examples of
competencies

• Collect and interpret data for the purpose of
  planning the evaluation and intervention process.
• Prepare a speech-language pathology conclusion to
  be shared efficiently with parents.
• Plan a preventive intervention.
• Question the accuracy of the evaluation and
  intervention conducted in a multidisciplinary
  context.
• Plan the organization of services while taking
  into account the various needs for the purpose of
  offering services to patients with multiple
  deficiencies.

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1. Choice of orientation Traditional /
Authentic evaluation

• Traditional evaluation
• Multiple Choice Short / Elaborate answer
• Evaluates only knowledge
• Relies on the lower levels of the taxonomy.

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1. Choice of orientation Traditional /
Authentic evaluation

• Authentic evaluation
• Case studies
• Rely on the upper levels of the taxonomy.
• Measure judgment the ability to make the best
  decisions in a complex situation.
• Take into account experience.
• Enable individuals to call upon all of their
  resources.
• Apply individual knowledge to a practical
  situation.

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2. Professional practice framework

• Six dimensions
• Actions 
• Practice environment
• Periods of life / ages
• Disabilities
• Dimensions of communication
• Rules of professional conduct

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2. Professional practice framework Example
Extract of the Matrix of an exam
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3. Choose the instrumentation

• Case structure
• Field
• Intentions of the evaluation
• Simulation exercice
• Questions - instructions
• Qualifying responses (A, B, C)
• Disqualifying responses (F)
• References

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3. Choose the instrumentation Example A
Written case of the Exam

• Adult Case Study
• Evaluation Intent
• (1) Evaluate the ability to identify a problem
  and make a decision during an emergency, in a
  safe manner, when dealing with a oro-pharyngeal
  dysphagia of a neurological nature.
• (2) Evaluate the candidates competence in
  anticipating possible situations and adapting
  interventions based on the different results
  obtained during the evaluation process.
• (3) Evaluate the ability to make pertinent
  recommendations to the different caregivers based
  on evaluation results.
• Case Designer
• Carmen Phénix, Speech-Language Pathologist,
  December 20, 2003
• Michèle Bergeron, Speech-Language Pathologist
  and Professor

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3. Choose the instrumentation Example A
Written case of the Exam

• The information that is shade is the only
  accessible to the candidate
• Time Allowed 60 minutes
• Background
• An urgent request from a physician is addressed
  to the speech-language pathology department of a
  short-term care hospital centre to evaluate a
  patients ability to feed himself orally.
• It appears the patient choked while drinking
  water.
• The hospital file shows the following
  information
• M. F., age 62, has been admitted to the Hospital
  Centre following a left hemiparesis and facial
  asymmetry.
• The emergency physician on duty diagnosed a
  stroke the cerebral axial tomography conducted
  upon arrival showed an old left parietal
  deficiency with no evidence of a recent stroke.
  M.F.s condition deteriorated during the course
  of the day.

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3. Choose the instrumentation Example A
Written case of the Exam

• During the night that followed the patients
  admission, M. F. showed signs of respiratory
  distress and was transferred to intensive care.
  A lung X-ray showed pneumonia.
• M. F. was then intubated with a nasogastric
  feeding tube. Intensive care notes read that M.
  F. pulled out his feeding tube on two occasions.
• Once the patients medical condition stabilized,
  on his third day at the hospital, he was
  transferred to the floor. Back in his room, he
  pulled out his feeding tube for the third time.
• The attending physician has asked the advice of
  the speech-language pathologist before
  reinstalling the nasogastric feeding tube. The
  feeding tube was removed last evening and M. F.
  is not being fed orally.

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3. Choose the instrumentation Example A
Written case of the Exam

• You go to M. F.s bedside he is sleeping but
  wakes up when called by his name. The obvious
  facial asymmetry is characterized by the drooping
  of the left lip corner and left cheek. The mouth
  is open when resting the tongue is white and
  crusted. The patient has no teeth and is leaning
  on his left side.
• M. F.s speech is almost unintelligible the
  attending medical staff does not clearly
  understand what he is saying.
• He manages to make you understand that he is
  thirsty and that he wants to drink a glass of
  water.

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3. Choose the instrumentation Example A
Written case of the Exam

• Instructions and Questions
• Q1. Precisely describe, in a few lines, the
  decision you have made as a speech-language
  pathologist, a few minutes following your arrival
  in the patients room. Briefly explain the plan
  of action resulting from your decision.
• Q2. In ten lines or so, propose two (2) possible
  speech-language pathologists intervention
  scenarios for the next few hours. For each
  scenario, describe plausible results and acts to
  be performed based on these results.
• Q3. Based on plausible results obtained in
  Question 2, what would your recommendations to
  the different caregivers be in either scenario?

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3. Choose the instrumentation Example A
Written case of the Exam

• For correctors only
• Qualifying Answers
• Decision Refuse to give any food orally before
  verifying the prerequisites for safe swallowing.
• Plan of Action
• (1)Verify the capacities to follow instructions
• a) the patients level of cooperation
• b) awareness of his deficits
• c) simple verbal understanding.

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3. Choose the instrumentation Example A
Written case of the Exam

• (2) Briefly evaluate the peripheric oral
  mechanism and structure movements in terms of
  swallowing
• lips, tongue, soft palate, uvular, teeth, sulci
• gag reflex
• saliva management
• secretions management
• voice quality (clear, hoarse, wet)
• gag reflex
• cough (spontaneous and on demand)
• spontaneous swallowing of saliva
• laryngeal elevation during swallowing saliva.
• (3) Verify the patients ability to use
  oropharyngeal structures, such as moving his
  tongue, closing mouth, swallowing saliva,
  coughing on demand, etc.

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3. Choose the instrumentation Example A
Written case of the Exam

• Disqualifying Answers
• Minimal error
• Leave the room without attempting any
  intervention on the patient saying that he needs
  a nasogastric feeding tube.
• Major errors
• Immediately give a glass of water.
• Proceed with food tests before evaluating the
  prerequisites for safe swallowing.

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3. Choose the instrumentation Example A
Written case of the Exam

• A The 3 qualifying actions, well described, full
  of substance, with a) b) c)and no disqualifying
  action.
• B The 3 qualifying actions described summarily
  and no disqualifying action.
• C 2 of the 3 qualifying actions or the minimal
  error in disqualifying answers with good
  explanations (danger of pneumonia, patient
  attitude, suggestion to keep NPO and to proceed
  to a modified barium swallow, recommendation to
  install the feeding tube).
• F One of the 2 major errors in disqualifying
  answers or the minimal error with no explanation.

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4. Develop the Education Equivalence
Recognition Exam (EERE)

• Based on realistic case studies to assess the
  candidates competencies.
• Based on a professional practice framework (12
  case studies).
• Two trials
• First trial (masters degree students
  professional potential candidates)
• - ascertain whether candidates are able to
  respond to this type of examination
• - make sure that the exam is neither too
  difficult nor too easy
• - check the response time for each case
  (duration of the exam 1½ days).
• Second trial (potential candidates)
• - make sure that the exam is neither too
  difficult nor too easy
• - check the response time for each case
  (duration of the exam 1½ days)
• - determine the success profile.
• Two exams
• 12 writing cases 2 oral cases 2 days.

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5. Correction methodology Elaborate an
evaluation rubric

• An evaluation rubric is a scoring tool that
  indicates the specific expectations for an
  assignment.
• Rubrics divide an assignment into its component
  parts and provide a detailed description of what
  constitutes acceptable or unacceptable levels of
  performance for each of those parts (Stevens and
  Levis, 2005).
• Component parts
• A rating scale.
• The dimensions, components and criteria
  pertaining to the evaluation.
• A description of levels of performance.
• Comments on the overall evaluation.
• All of the components form a grid

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5. Correction methodology
Example of a Rubric
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6. Validation steps

• Validation is an important matter Six types
• Training cases writer.
• Content and representation of the domain by
  experts two experts.
• Two experimentations and Result analysis.
• Examinees (experimentation) Questionnaire on
  each case and discussion after the exam.
• Double correction questionnaire on each case
  prior training and subsequent interview with test
  scorers.
• Analyses of the results
• consistency between test scorers (2 1)
• success rate for each case (difficulty and
  discrimination)
• of successful candidates.

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7. Elaborate the Success profile Example of
a results reporter in a matrix (extract)
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7. Elaborate the Success Profile
Example of an extract
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8. Communication of the Results
Recommendation Decision

• Three possible decisions
• Success 75 - 9/12 - 11/14) Stage.
• Partial success 60 - (8/12 - 9/14) Partial
  examination rewriting.
• Fail Masters degree required or complete
  examination rewriting.

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9. Timetable for carrying out the different
stages (June 2002 Fall 2006)
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Issues related to cooperation and the
harmonization of standards

• Globalization
• Opening of markets
• Remote services
• Manpower mobility
• Labour shortages.
• Obligation to display competence, integrity and
  efficacy.
• Ensure protection of the public.

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Cooperation and the harmonization of
standardsWhat?

• The better harmonization of standards between
  jurisdictions (the maintenance of high standards)
  must take into account various facets
• legal
• cultural
• social related to individuals
• linguistic
• service organization related to service delivery

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Cooperation and the harmonization of
standardsHow?

• Exchanges between jurisdictions that respect each
  ones management autonomy
• study similarities and differences
• indicate to other jurisdictions the specific
  provisions of a given jurisdiction
• scope and limitations of obligations from the
  standpoint of equivalence and processes to
  discharge the jurisdictions responsibilities.

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Cooperation and the harmonization of
standardsHow?

• Give regulatory bodies the power and means
  to act
• ensure through legislation sufficiently clear,
  flexible powers to allow for full or partial
  equivalence
• seek to harmonize legislative provisions between
  jurisdictions.

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Cooperation and the harmonization of
standardsHow?

• Establish common references (a corpus for the
  discipline, the skills required to engage in the
  profession).
• Show that the entire body of knowledge and skills
  pertaining to the profession is evaluated in
  respect of a candidate wishing to engage in the
  profession (especially in a training equivalence
  process).

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Cooperation and the harmonization of
standardsHow?

• Offer additional training to certain candidates
  when appropriate.
• Rely on universities and other training
  institutions.

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Cooperation and harmonization of standards and
transfer of acquired expertise - With?

• The exam will prove an essential tool to evaluate
  competence and identify problems, as the case may
  be.
• Design the entire corpus of knowledge and skills
  required for professional practice in order to
  measure them.
• Modularity seek to define a threshold to engage
  in a profession.

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Transfer of acquired expertise For?

• A tool that will facilitate the integration of
  immigrants, and more?

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Transfer of acquired expertise and cost efficiency

• Interchangeable framework
• from a theoretical and conceptual standpoint
• from a methodological standpoint.
• Adaptation of content by profession, bearing in
  mind cultural and social facets as service
  organization and delivery.

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Transfer of acquired expertise and cost efficiency

• Interchangeable framework
• Transfer of the acquired expertise and adaptation
  to a given profession and to other regulated
  professions or occupations.
• Jointly develop and refine the tools
  (interpretation, evaluation, training and
  information).
• Ensure in a responsible manner that the process
  and the partnership are robust and durable.

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Cooperation and harmonization of standards and
cost efficiency

• Financial support required
• Obtain government financial support.
• The reception and integration of immigrant
  professionals is a responsibility that is shared
  with the government, especially against a
  backdrop of scarce resources.

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Conclusion

• Joint efforts.
• Transfer experience and expertise.
• Collaboration for development.
• Harmonize standards and practices.

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Thank you for your attention
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Speaker Contact Information

• Speaker Name Mr. Louis Beaulieu
• Organization Ordre des orthophonistes et
  audiologistes du Québec
• Address 235, boul. René-Lévesque Est,
• Montréal (Québec) H2X 1N8
• Phone [phone] Fax [phone]
• E-mail lbeaulieu_at_ooaq.qc.ca
• Website www.ooaq.qc.ca

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MRCI\Présentation CLEAR 2006\PPCLEAR 2006 Final