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“ Globalization and Labour Mobility: Jurisdictional Cooperation”

Expect the Unexpected: Are We Clearly Prepared?. “ Globalization and Labour Mobility: Jurisdictional Cooperation”. Alexandria, VA – September, 15 2006 Ordre des orthophonistes et audiologistes du Québec (OOAQ) (professional order of Québec speech-language pathologists and audiologists).

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“ Globalization and Labour Mobility: Jurisdictional Cooperation”

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  1. Expect the Unexpected: Are We Clearly Prepared? “Globalization and Labour Mobility: Jurisdictional Cooperation” 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 Presented at the 2006 CLEAR Annual Conference 1 September 14-16 Alexandria, Virginia 2006 Annual Conference Alexandria, Virginia

  2. 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 Presented at the 2006 CLEAR Annual Conference 2 September 14-16 Alexandria, Virginia

  3. 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 Organization of the presentation Presented at the 2006 CLEAR Annual Conference 3 September 14-16 Alexandria, Virginia

  4. 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 Presented at the 2006 CLEAR Annual Conference 4 September 14-16 Alexandria, Virginia

  5. Legal, political, professional and organizational issueRegulatoryobligations Two ways of proceeding • Diploma equivalence • Training equivalence (substantially equivalency) Presented at the 2006 CLEAR Annual Conference 5 September 14-16 Alexandria, Virginia

  6. Legal, political, professional and organizational issueRegulatoryobligations • Diploma equivalence Recognition by the Board of a professional order that a diploma issued by an educational institution located outside Québec certifies that a candidate’s level of knowledge and skills is equivalent to the level of a diploma giving access to the permit. Presented at the 2006 CLEAR Annual Conference 6 September 14-16 Alexandria, Virginia

  7. Legal, political, professional and organizational issuesRegulatoryobligations • Training equivalence (substantially equivalency):  by regulation recognition by the Board that a candidate’s 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. Presented at the 2006 CLEAR Annual Conference 7 September 14-16 Alexandria, Virginia

  8. Legal, political, professional and organizational issueRegulatoryobligations • Recognition of acquiredknowledge 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. Presented at the 2006 CLEAR Annual Conference 8 September 14-16 Alexandria, Virginia

  9. General process objectives • Ensure public protection • Meet one of the OOAQ’s responsibilities in terms of admission to the practice • Recognize master’s 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 Presented at the 2006 CLEAR Annual Conference 9 September 14-16 Alexandria, Virginia

  10. Legal, political, professional and organizational issuesRegulatoryobligations • 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) Presented at the 2006 CLEAR Annual Conference 10 September 14-16 Alexandria, Virginia

  11. Legal, political, professional and organizational issuesRegulatoryobligations 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 Presented at the 2006 CLEAR Annual Conference 11 September 14-16 Alexandria, Virginia

  12. Legal, political, professional and organizational issuesRegulatoryobligations 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 candidate’s discretion) Presented at the 2006 CLEAR Annual Conference 12 September 14-16 Alexandria, Virginia

  13. Legal, political, professional and organizational issuesRegulatory 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. Presented at the 2006 CLEAR Annual Conference 13 September 14-16 Alexandria, Virginia

  14. Legal, political, professional and organizational issuesRegulatory obligations Professional issues • Adopt an approach that takes into account the candidate’s 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 Presented at the 2006 CLEAR Annual Conference 14 September 14-16 Alexandria, Virginia

  15. Legal, political, professional and organizational issuesRegulatory 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. Presented at the 2006 CLEAR Annual Conference 15 September 14-16 Alexandria, Virginia

  16. Legal, political, professional and organizational issuesRegulatory obligations Organizational issues • Establish a clear, indisputable process. • Regularly elaborate a “new” exam. • Funding and enduring nature. Presented at the 2006 CLEAR Annual Conference 16 September 14-16 Alexandria, Virginia

  17. (3) Conceptual and methodological elements linked to the development of the Education Equivalence Recognition Exam (EERE) Presented at the 2006 CLEAR Annual Conference 17 September 14-16 Alexandria, Virginia

  18. Ministère de l’Immigration et des Communautés culturelles du Québec + Volunteer work The project is funded by the Presented at the 2006 CLEAR Annual Conference 18 September 14-16 Alexandria, Virginia

  19. 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 OOAQ’s registration committee Fréderic Lapointe, doctoral student, Faculty of Education, Université de Montréal Joseph N’Kuba, doctoral student, Faculty of Education, Université de Montréal Research team Presented at the 2006 CLEAR Annual Conference 19 September 14-16 Alexandria, Virginia

  20. 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. Presented at the 2006 CLEAR Annual Conference 20 September 14-16 Alexandria, Virginia

  21. 1. Choice of orientation: Objectives – Competencies Cognitive objectives (taxonomy - Bloom, 1956) 6. Evaluation 5. Synthesis 4. Analysis 3. Application 2. Comprehension 1. Knowledge + Complexity | Presented at the 2006 CLEAR Annual Conference 21 September 14-16 Alexandria, Virginia

  22. 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) Presented at the 2006 CLEAR Annual Conference 22 September 14-16 Alexandria, Virginia

  23. 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. Presented at the 2006 CLEAR Annual Conference 23 September 14-16 Alexandria, Virginia

  24. 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. Presented at the 2006 CLEAR Annual Conference 24 September 14-16 Alexandria, Virginia

  25. 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. Presented at the 2006 CLEAR Annual Conference 25 September 14-16 Alexandria, Virginia

  26. 2. Professional practice framework Six dimensions • Actions  • Practice environment • Periods of life / ages • Disabilities • Dimensions of communication • Rules of professional conduct Presented at the 2006 CLEAR Annual Conference 26 September 14-16 Alexandria, Virginia

  27. 2. Professional practice framework Example – Extract of the Matrix of an exam Presented at the 2006 CLEAR Annual Conference 27 September 14-16 Alexandria, Virginia

  28. 3. Choose the instrumentation Presented at the 2006 CLEAR Annual Conference 28 September 14-16 Alexandria, Virginia Case structure • Field • Intentions of the evaluation • Simulation exercice • Questions - instructions • Qualifying responses (A, B, C) • Disqualifying responses (F) • References

  29. 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 candidate’s 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 Presented at the 2006 CLEAR Annual Conference 29 September 14-16 Alexandria, Virginia

  30. 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 patient’s 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. Presented at the 2006 CLEAR Annual Conference 30 September 14-16 Alexandria, Virginia

  31. 3. Choose the instrumentation …Example – A Written case of the Exam… • During the night that followed the patient’s 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 patient’s 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. Presented at the 2006 CLEAR Annual Conference 31 September 14-16 Alexandria, Virginia

  32. 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. Presented at the 2006 CLEAR Annual Conference 32 September 14-16 Alexandria, Virginia

  33. 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 patient’s room. Briefly explain the plan of action resulting from your decision. Q2. In ten lines or so, propose two (2) possible speech-language pathologist’s 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? Presented at the 2006 CLEAR Annual Conference 33 September 14-16 Alexandria, Virginia

  34. 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 patient’s level of cooperation; b) awareness of his deficits; c) simple verbal understanding. Presented at the 2006 CLEAR Annual Conference 34 September 14-16 Alexandria, Virginia

  35. 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 patient’s ability to use oropharyngeal structures, such as moving his tongue, closing mouth, swallowing saliva, coughing on demand, etc. Presented at the 2006 CLEAR Annual Conference 35 September 14-16 Alexandria, Virginia

  36. 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. Presented at the 2006 CLEAR Annual Conference 36 September 14-16 Alexandria, Virginia

  37. 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 The3 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. Presented at the 2006 CLEAR Annual Conference 37 September 14-16 Alexandria, Virginia

  38. 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 (master’s 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. Presented at the 2006 CLEAR Annual Conference 38 September 14-16 Alexandria, Virginia

  39. 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 Presented at the 2006 CLEAR Annual Conference 39 September 14-16 Alexandria, Virginia

  40. 5. Correction methodology Example of a Rubric Presented at the 2006 CLEAR Annual Conference 40 September 14-16 Alexandria, Virginia

  41. 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. Presented at the 2006 CLEAR Annual Conference 41 September 14-16 Alexandria, Virginia

  42. 7. Elaborate the Success profileExample of a results reporter in a matrix (extract) Presented at the 2006 CLEAR Annual Conference 42 September 14-16 Alexandria, Virginia

  43. 7.Elaborate the Success Profile Example of an extract Presented at the 2006 CLEAR Annual Conference 43 September 14-16 Alexandria, Virginia

  44. 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 = Master’s degree required or complete examination rewriting. Presented at the 2006 CLEAR Annual Conference 44 September 14-16 Alexandria, Virginia

  45. 9. Timetable for carrying out the different stages – (June 2002 – Fall 2006) Presented at the 2006 CLEAR Annual Conference 45 September 14-16 Alexandria, Virginia

  46. 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. Presented at the 2006 CLEAR Annual Conference 46 September 14-16 Alexandria, Virginia

  47. 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 Cooperation and the harmonization of standardsWhat? Presented at the 2006 CLEAR Annual Conference 47 September 14-16 Alexandria, Virginia

  48. Exchanges between jurisdictions that respect each one’s 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 jurisdiction’s responsibilities. Cooperation and the harmonization of standardsHow? Presented at the 2006 CLEAR Annual Conference 48 September 14-16 Alexandria, Virginia

  49. 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. Cooperation and the harmonization of standardsHow? Presented at the 2006 CLEAR Annual Conference 49 September 14-16 Alexandria, Virginia

  50. 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). Cooperation and the harmonization of standardsHow? Presented at the 2006 CLEAR Annual Conference 50 September 14-16 Alexandria, Virginia

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