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Time: 11:00 – 12:00 PM | Session Type: Concurrent
Ontario
Regulators often struggle with managing repeat offenders who do not seem to have a desire to remediate, and many of us who work in professional regulation have wondered what drives professionals to engage in misconduct. When confronted with members who engage in less serious forms of misconduct that may not warrant revocation, many of us have also wondered whether a regulator’s standard tools to address the misconduct (e.g., coursework, mentorship, suspension) will be effective in ensuring that the misconduct at issue does not recur. During this interactive and controversial session, we will consider what tools regulators can employ from the psychotherapy and coaching fields to affect meaningful and lasting behavioural change among regulated professionals and better serve the regulator’s public interest mandate. Two regulators, the College of Physicians of Ontario and the College of Veterinarians of Ontario, will share their experiences managing these challenging and disruptive professionals. A psychotherapist will then be asked to provide insight into how to manage this problem faced by regulators.
Time: 11:00 – 12:00 PM | Session Type: Concurrent
Alberta, British Columbia
Boundary violations are not new within health profession regulation. Conduct once perceived as tolerable is increasingly viewed as abuse or misconduct as societal expectations regarding professional conduct have evolved. To be clear, these behaviours have never been deemed acceptable professional conduct, however the threshold for conduct leading to sanction has changed over time. Regulators have encountered an increase in complaints of this nature in recent years. In some jurisdictions, provincial governments have passed legislation directly addressing sexual misconduct and sexual abuse of patients by regulated health professionals and establishing mandatory sanctions when such situations arise. In other jurisdictions, comparable legislative action has not occurred. This session will discuss:
The session will provide food for thought for regulators that are considering addressing this risk.
Time: 12:00 – 12:30 PM
Moderated Discussions
Breakouts
Time: 12:30 – 12:45 PM
Break
Time: 12:45 – 1:45 PM | Session Type: General Session
National
Risk-based regulation, a proactive approach to regulation which focuses on mitigating and preventing risks to the public stemming from the practice of the profession, is a modern approach to regulation pursued by regulatory bodies worldwide. This type of regulation enables a regulatory body with finite resources to determine the riskiest activities the practice of their profession poses to the public and allocate resources towards preventing and mitigating them. This session is meant to provide practical tools and learning for implementing or improving risk-based regulation practices that delegates can apply to their own regulatory environments. This will include a detailed look at HRPA’s own development of a risk register that was developed with having limited complaints data, as well as the development of a Risk-Based Regulation Practice-Based Assessment Tool, which identifies key practices that are or should be demonstrated by a risk-based regulator and an achievement rating-scale that has been informed by scouring the literature, presentations, and consulting with risk-based regulation experts. Delegates attending this session will learn:
Time: 1:45 PM – 2:00 PM
Break
Time: 2:00 PM – 3:00 PM | Session Type: Concurrent
Ontario
The COVID-19 pandemic and associated lockdowns have provoked a surge in mental health and substance use problems in the population, including among regulated professionals. Mental illnesses and substance use disorders affect many people, of all ages, education, and income levels, including regulated professionals. As a result, there appears to have been an increase in reports to regulatory Colleges about members regarding their fitness to practise, including to regulatory Colleges who may have rarely or never had to manage these issues in the past. The objective of this presentation is to teach delegates about the newest approaches and the future of fitness to practise for regulated professionals with mental health and/or substance use disorders in a variety of different professions. The panel members include:
1) a regulator, the College of Nurses of Ontario, with a history of approximately a hundred referrals to their Fitness to Practise Committee per year as well as a new voluntary Nurses’ Health Program (NHP) launched in 2019;
2) a lawyer who has prosecuted hundreds of cases referred to the Fitness to Practise Committee of various Colleges; and
3) a psychiatrist and addiction medicine physician who has conducted hundreds of assessments of regulated professionals.
We will address some of the frequently asked questions about fitness to practise, such as:
TIME: 2:30 PM – 3:00 PM | SESSION TYPE: CONCURRENT
Ontario
Regulating health professionals during a pandemic presents unique challenges for regulators. Some of the most difficult challenges flow from the intersection of public health guidance with the diversity of views among health professionals concerning many aspects of COVID-19 and how best to deal with the pandemic. The novelty of the coronavirus, the developing state of medical knowledge and changes in public health guidance all exacerbate the situation. In this difficult (and sometimes politically charged) environment, how can regulators best protect the public and provide guidance to their members? Some regulators have published guidance about appropriate communication concerning public health advice and COVID restrictions, as well as compliance with those restrictions. That guidance recognizes that regulated health professionals are in positions of leadership and public trust, making their views on health matters influential, whether communicated on social media or in other forums. In this way, statements made by professionals in public forums have the potential to impact public health and safety. Other regulators have held members accountable for tweets and social media posts that undermine public health advice, particularly where the communications were made without sufficient context or supporting evidence and were viewed as potentially putting the public at risk. On the one hand, there is obviously a diversity of scientific/ medical opinion about COVID-19 risks, public health restrictions and vaccines and a reluctance to stifle legitimate discussion and debate. On the other hand, regulators have been concerned about the real risks posed by members who use their professional status to undermine public health advice by their communications and actions (without sufficient evidentiary foundation or context). This session will explore how regulators have addressed the challenge of regulating their members’ communications and conduct in relation to public health advice during the COVID-19 pandemic and some of the lessons learned to date.
Time: 3:00 – 4:00 PM
Virtual Networking Event
Technology/Testing
Time: 11:00 – 12:00 PM | Session Type: Plenary
Canada, Australia
The popularity of digital platforms has prompted some to argue that occupational licensing models should be updated to reflect this emerging trend. For example, the idea was raised by the Government of the United Kingdom nearly a decade ago when considering the licensing of health workers, social workers and social care workers. The European Commission and the American Federal Trade Commission have also praised these online mechanisms for generating valuable information while reducing market failures and consumer risks. Recent studies go further and suggest that online reviews and ratings may even be a “de facto substitute for” professional licensing bodies. Some have advocated for a “co-regulatory framework” where regulators incorporate information gleaned from online reviews. Although rating mechanisms may play an important role in regulating professions, they have to be viewed with caution. This presentation discusses how leaders of occupational licensing bodies in Canada, Europe, the United States and Australia have considered how online consumer review platforms might be one way to address some shortcomings of occupational licensing and how today’s regulatory leaders could consider their use. It will also consider the concerns that online ratings platforms are unreliable and that there is too much opportunity for them to be based on impressions that are largely irrelevant for a regulator.
Time: 12:00 – 12:15 PM
Break
Time: 12:15 – 1:15 PM | Session Type: Concurrent
National, Ontario
Virtual remote proctored assessments, necessitated by the COVID-19 Pandemic, can reliably assess performance, and are likely here to stay. This discussion will describe how a tablet based MCQ and 12 station Objective Structured Clinical Exam (OSCE) for nursing was reformatted and successfully administered. The Internationally Educated Nurse Assessment Program (IENCAP) is designed to determine RN equivalence in Ontario. With 800 registrants whose exams were cancelled, and referrals continuing throughout the pandemic, an alternative approach to in person testing was required. The Virtual IENCAP launched in February 2021, with the OSCE administered by ZOOM application paired with a purpose built web platform, and the MCQ on a UCAN consortium platform with live and AI assisted proctoring. Participants in this panel will describe the challenges faced in redevelopment and administration, and address issues of security, reliability, validity and access. Perspectives will include Touchstone Institute’s, covering logistical challenges and psychometric performance, along with the Lead Nurse Examiner’s, describing how content was adapted and authenticity maintained in the virtual environment. In Ontario the Fairness Commissioner makes sure that certain regulated professions, including nursing, have registration practices that are transparent, objective, impartial and fair. Access to assessments required in registration pathways has been a significant issue for many professions in Ontario during the pandemic. A representative from the office of the Fairness Commissioner will reflect on how testing strategies, such as virtual OSCEs, can support those seeking licensure. Together, participants will comment on the role of remote virtual testing in the future as an important and proven modality that can broaden access to assessment.
Time: 12:15 -1:15 PM | Session Type: Concurrent
National, Ontario, Alberta, Newfoundland and Labrador
Credentialing organizations are faced with increased volumes of requests for testing accommodations and must carefully balance the access needs of candidates with disabilities with their mission to ensure safe and effective practice. With the increased use of online proctoring as an exam delivery modality, as an alternative or in conjunction to test centre delivery, there are a number of considerations to review and evaluate in providing testing accommodations. This panel will discuss challenges and opportunities as it relates to testing accommodations through different modalities, including online proctoring and in test centre, or from a hybrid offering. Key topics to be addressed include: – Communications with candidates: What, how, and when – Opportunities and flexibility of various types of testing accommodations based on exam delivery modality – Challenges for certain types of accommodations based on exam delivery modality – How to manage candidates’ expectations and where to draw the line in providing testing accommodations – Considerations in reviewing and implementing testing accommodations Examples will be discussed along with key applications from a program perspective, leveraging the experience from the three individuals representing different testing or regulatory organizations. This discussion will provide an opportunity to outline options for testing accommodations and appropriate parameters for reviewing accommodations requests, communicating decisions, and implementing accommodations while preserving the integrity of the testing program.
Time: 1:15 – 1:45 PM
Moderated Discussions
Breakouts
Time: 1:45 PM – 2:00 PM
Break
Time: 2:00 PM – 3:00 PM | Session Type: Concurrent
National
The Canadian Alliance of Physiotherapy Regulators (CAPR) is a pan-Canadian federation of provincial/ territorial organizations that regulate physiotherapy in Canada. On behalf of the regulators, CAPR administers the Physiotherapy Competency Examination (PCE) to evaluate candidates’ readiness for safe, effective, and independent practice. Like most high-stakes testing organizations, CAPR was forced to make significant adjustments to how assessments are conducted due to COVID-19. CAPR was able to successfully administer the PCE Written Component (a multiple-choice exam) in 2020 by incorporating remote proctoring as an adjunct to brick-and-mortar test centre delivery; however, a solution for safely administering the PCE Clinical Component (a performance-based exam) was more complicated due its “hands on” nature and requirement of close physical proximity between candidates, standardized clients, and examiners. In response to public health directives, CAPR made the difficult decision to cancel the Clinical Component in 2020. While this decision had a significant negative impact on candidates waiting to become fully licensed physiotherapists, it presented a timely opportunity for CAPR to innovate and re-envision how to assess candidates in 2021 without relying on physical exam sites. In this session, attendees will learn how CAPR navigated through an ambitious 6-month project to develop and deliver a virtual clinical exam.
Topics of discussion include:
(a) the existing governance structure that enabled CAPR to rapidly shift from an in-person to a virtual exam,
(b) the design, structural and content modifications required to administer a safe and psychometrically sound exam,
(c) the steps taken to validate exam content and prepare candidates for the virtual exam, and
(d) the planned use of technology to securely deliver the exam.
Attendees will also learn that, despite extensive preparatory work and multi-stage testing with third party vendors, the launch of CAPR’s first fully online exam was unsuccessful. Challenges and lessons learned will be shared.
TIME: 2:00 PM – 3:00 PM | SESSION TYPE: CONCURRENT
Quebec
La pandémie a clairement accéléré le déploiement de l’offre de services professionnels à distance et de nouveaux modèles d’affaires, ce qui entraîne des enjeux importants, notamment dans le domaine de la santé et relations humaines. En contexte interjuridictionnel, les leviers dont disposent les organismes de réglementation pour protéger le public ne sont pas toujours adaptés. De récents jugements nous rappellent que la portée des pouvoirs de ces organismes est parfois limitée quand le client et le professionnel ne sont pas dans la même juridiction. Au Québec, le cadre législatif et réglementaire ne traite pas spécifiquement de la télépratique en contexte interjuridictionnel. Ainsi, plusieurs positions coexistent au sein des organismes de réglementation à l’égard de l’encadrement de la télépratique. Ce contexte n’est pas propre au Québec. Comment protéger le public et s’assurer que l’encadrement offert demeure efficace et pertinent lorsque les services professionnels sont offerts à distance par des personnes situées à l’extérieur de notre juridiction? Soucieux de contribuer à cette réflexion et d’orienter les acteurs du système professionnel, le Conseil interprofessionnel du Québec (CIQ) s’est penché sur les enjeux afférents à la télépratique. Au terme de ses travaux, il a produit un rapport qui présente sept principes clés pour l’encadrement de la télépratique en contexte interjuridictionnel. Ces principes constituent un cadre d’analyse qui pourra inspirer tout organisme de réglementation.
Au cours de la présentation, les conférenciers présenteront :
– Sensibiliser aux enjeux afférents à la télépratique en contexte interjuridictionnel;
– Faire connaître les principes élaborés par le CIQ, de même que d’autres pistes de réflexion inspirées de solutions retenues dans d’autres juridictions.
The pandemic has clearly accelerated the deployment of remote professional services and new business models, which raises important issues, particularly in the health and human relations field. In an inter-jurisdictional context, the levers available to regulatory bodies to protect the public are not always adequate. Recent judgments remind us that the scope of these bodies’ powers is sometimes limited when the client and the professional are not in the same jurisdiction. In Quebec, the legislative and regulatory framework does not specifically address telepractice in an inter-jurisdictional context. Thus, several positions coexist within the regulatory bodies with respect to the supervision of telepractice. This context is not unique to Quebec. How can we protect the public and ensure that the framework offered remains effective and relevant when professional services are offered at a distance by persons located outside our jurisdiction? In an effort to contribute to this reflection and to guide the players in the professional system, the Conseil interprofessionnel du Québec (CIQ) has examined the issues related to telepractice. At the end of its work, it produced a report that presents seven key principles for the supervision of telepractice in an interjurisdictional context. These principles provide a framework for analysis that can be used by any regulator. During the presentation, the speakers will present – The key principles developed by the CIQ, as well as other avenues of reflection inspired by solutions adopted in other jurisdictions.
The presentation has two objectives:
Time: 3:00 – 3:30 PM
Moderated Discussions
Breakouts
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