Transcript Document

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 2006 Annual Conference September 14-16 Alexandria, Virginia Alexandria, Virginia 1

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 September 14-16 Alexandria, Virginia 2

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 Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia 3

Legal, political, professional and organizational issues

Legal 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 September 14-16 Alexandria, Virginia 4

Legal

, political, professional and organizational issue

Regulatory obligations

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

Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia 5

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 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 September 14-16 Alexandria, Virginia 6

Legal

, political, professional and organizational issues

Regulatory obligations

• 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.

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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 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 September 14-16 Alexandria, Virginia 9

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) Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia 10

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 Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia 11

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 candidate’s discretion) Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia 12

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 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 September 14-16 Alexandria, Virginia 14

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. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia 15

Legal, political, professional and

organizational

Regulatory obligations

issues

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)

Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia 17

The project is funded by the

Ministère de l’Immigration 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 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 Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia 19

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

5.

6.

7.

8.

9.

Issues and considerations

1.

2.

3.

4.

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 Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia 21

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 September 14-16 Alexandria, Virginia 22

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

1. Actions 2. Practice environment 3. Periods of life / ages 4. Disabilities 5. Dimensions of communication 6. Rules of professional conduct Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia 26

2. Professional practice framework Example – Extract of the Matrix of an exam

Cases

Activities or Tasks:

Minutes: Gathering Data Planning the Evaluation Analyzing and Interpreting Planning the Intervention

Fields of Practice:

Health Sector CLSC CHCD CR CHSLD Education Sector Private Sector

Stages of Life:

Preschool Age School Age Adulthood Elderly or with Diminishing Abilities

Deficiency/Handicap:

Stuttering Sensory Dysarthria Dysphagia

Communication Aspects:

Formal Semantic Pragmatic Discursive AAC

1

20

X X X X X X X 13

30

X X X X X 7

30

X X X X X X X X X X X X 12

30

X X X X X X X 15

45

X X X X X 4

45

X X X X X X 2

45

X X X X X 5

60

X X 19

45

X X X X X X X X X X X 18

60

X X X X X X 17

60

X X X X X 24

45

X X X X X X

27 September 14-16 Alexandria, Virginia

3. Choose the instrumentation

Case structure

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

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 September 14-16 Alexandria, Virginia 29

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.

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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.

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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 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?

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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 patient’s 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: a) lips, tongue, soft palate, uvular, teeth, sulci; b) gag reflex; c) saliva management; d) secretions management; e) voice quality (clear, hoarse, wet); f) i) gag reflex; g) cough (spontaneous and on demand); h) 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.

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3. Choose the instrumentation … Example – A Written case of the Exam… Disqualifying Answers Minimal error

1. Leave the room without attempting any intervention on the patient saying that he needs a nasogastric feeding tube.

Major errors

2. Immediately give a glass of water.

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

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

o 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).

o 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 exams12 writing cases + 2 oral cases = 2 days. Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia 38

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

1. A rating scale. 2. The dimensions, components and criteria pertaining to the evaluation.

3. A description of levels of performance.

4. Comments on the overall evaluation.

All of the components form a grid

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5. Correction methodology Example of a Rubric Candidate ____ Childhood Stuttering (2) Time Allowed: 45 min.

For each criterion, check off the box that corresponds to your judgement.

Marking Criteria 1.1 Accurate identification of the severity of the patient’s stuttering 2.1 Accurate and thorough intervention approaches 2.2 Accurate specification of current trend 3.1 Recommendations to parents and teacher

(at least 3 recommendations)

Quality of answer Excellent A

Accurate identification of the severity of the patient’s stuttering. The proposed approaches are entirely accurate and thorough, including the indirect intervention. Current trend specification is accurate.

The proposed recommendations are pertinent and thorough. (more than 3 recommendations) The candidate is in control of the situation – Answers are

Very Good B

The proposed approaches are accurate but somewhat incomplete. Current trend specification is partially accurate. The proposed recommendations are not entirely pertinent or are incomplete. (3 recommendations or less) Answers are accurate and coherent but incomplete.

Poor C

Several proposed elements are inaccurate or approaches are definitely incomplete. Current trend specification is more inaccurate than accurate.

The proposed recommendations are insufficient or inadequate. (2 recommendations or less) Answers are not always accurate. They might be incoherent or

Failed F

Incorrect identification of the severity of the patient’s stuttering. Absence of intervention or intervention totally inappropriate. No specification. No recommendation or inappropriate recommendations. The candidate is not in control of the situation. His/her comments coherent and clearly explained. unrealistic.

Criterion Significance: Fundamental ; Highly

Important

; Important

are vague or inappropriate.

Overall Evaluation Passed _____ Failed _____

Recommendation, if necessary.

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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) Réf Cas Bnq

20Biling 2.1.1 27TCC 2.2.1 2.3.1 QR Global 3.1.1 3.2.1 23Dysorth 3.2.2 3.3.1 QR Global 7.1 7.2 QR

W1 W1 W1 W2 W2 W2 W3 W3 W3 W4 W4 W4 W7 W7 W7 M S A M S A M S A M S A M S A

F F F 1 F C 1 C C 0 A B 1 C C C 0 B F B 4 B F B 4 C F B 4 F F F C B 1 F C B 1 C F C 1 F C 1 F C 1 F F F 0 C C 0 B C B 1 C C 0 C B 1 F F B 1 B A 1 C B A 1 B C A 4 B A 1 C C B 1 B A 1 C C B 1 S S S S A 1 B C 0 A S B 0 A 0 B B B S B B C C C C B 0 C C 1 C B 0 C S F 0 A B 0 B C 0 B C C 0 C C 0 C C 0 B F S 1 B B 1 C C 1 B C C 0 C C 0 C B o C S S 0 B C 0 B A 1 B B C 0 B B 1 B B 1 A S S 1 B B 1 F F 0 B F B 0 B 0 B 1 S 0 0 4 Global 7DysphasScol 9.1 9.2 9.3 QR Global S S S S C F B 4 S S S S F C 1 B F A 9 F F A A 0 B A 1 C C B 1 F B 4 B C B 1 B B 0 B B 0 F F F 0 B C B 1 F F S F C 1 B F B 4 F C 1 C C B 1 F F? S F S E A 9 C A 4 S S Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia C A 4 B A 1 S S 42

7. Elaborate the Success Profile Example of an extract Competencies Results C1 Results C2 Results C3 Actions / Tasks 7/13 = 54% 8/13 = 62% 7/13 = 54%

Data collection Planning of the evaluation Analysis and interpretation Sharing of information Planning of the intervention

… Dimensions of communication

Understanding Form Semantics Pragmatics Discursive

… Disabilities

50% 2/4 57% 4/7 56% 5/9 56% 5/9 44% 4/9 75% 3/4 50% 2/4 57% 4/7 57% 4/7 67% 6/9 70% 7/9 78% 7/9 44% 4/9 67% 6/9 67% 6/9 83% 5/6 83% 5/6 75% 3/4 75% 3/4 83% 5/6 83% 5/6 100% 4/4 100% 4/4 80% 4/5 80% 4/5 83% 5/6 83% 5/6 100% 4/4 100% 4/4 60% 3/5 Stuttering Sensorial Dysarthria Dysphagia Dysphonia

… Practice environments

Hospital Rehabilitation centre School Private

… Periods of life

Preschool School Adult Elderly

Fail

33% 1/3 80% 4/5 75% 3/4 50% 2/4 50% 2/4 20% 1/5 33% 1/3 0% 0/1

Fail

0% 0/3 60% 3/5 100% 4/4 50% 2/4 75% 3/4 100% 5/5 0% 0/3 0% 0/1

Fail

50% 2/4 50% 3/6 75% 3/4 60% 3/5 33% 1/3 80% 4/5 50% 2/4 100% 1/1 Pink = Fail Green = 0/1 Yellow = Boarder line Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia 43

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.

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9. Timetable for carrying out the different stages – (June 2002 – Fall 2006) July 2003 May 2004 March 2005 December 2006

Month / Year

Stage First step PREPARATION Define the model Train Draft case studies Revise Second and third steps TESTS Experimentation Validation Correction Analyses Modifications June 2002 One year Fourth and fifth steps EXAMS Preparation Validation Correction Analyses Decision PRE-TEST Seven months Seven months FIRST EXAM SECOND EXAM TEST Seven months Seven months

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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 standards What?

• The better harmonization of standards between jurisdictions – legal (the maintenance of high standards) must take into account various facets: – cultural – social – linguistic – service organization related to individuals related to service delivery Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia 47

Cooperation and the harmonization of standards How?

• 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.

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Cooperation and the harmonization of standards How?

• 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 standards How?

• 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 standards How?

• 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 : E-mail : Website : (514) 282-9123 Fax : (514) 282-9541 [email protected]

www.ooaq.qc.ca

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O:\Comités\Statutaires\Admission\Examen MRCI\Présentation CLEAR 2006\PPCLEAR 2006 Final Presented at the 2006 CLEAR Annual Conference September 14-16 Alexandria, Virginia 60