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International Optometric Bridging Program FAQ

 

Why does the optometric profession in Canada have an International Bridging Program?

The program was created in collaboration with the College of Optometrists of Ontario to ensure that the profession in Ontario had a fair, transparent, impartial and objective way to register internationally educated optometrists (North American optometric graduates are defined as those who have successfully completed an optometry program in Canada or the United States that is accredited by the Accreditation Council on Optometric Education, ACOE.  International optometric graduates (IOGs) are graduates of an optometry program other than an ACOE-accredited program).   The goal was to ensure that a fair system was in place to assist qualified IOGs to put their skills to work in a timely manner by recognizing their current education and work experience, identifying gaps and having a process  to bridge those gaps to Canadian levels.

The goal of this program was to reduce barriers to registration faced by IOGs in Canada including: educational gaps; lack of occupation-specific language and communication skills; inexperience with Canadian clinical techniques; cultural differences; a need for Canadian workplace experience; insufficient or confusing information regarding the registration process, and insufficient familiarity with the format and structure of the Canadian Assessment of Competence in Optometry (CACO) and its predecessor (Canadian Standard Assessment of Optometry, CSAO).

In 2003, the College of Optometrists of Ontario, COO, contracted University of Waterloo School of Optometry,UWSO, to work together to develop and implement a pilot study that provided a small number of IOGs with a concentrated, one-week program that consisted of a Prior Learning Assessment (PLA) of optometric knowledge and clinical skills, followed by a two week bridging program. 

Based on the success of the pilot program, development of the IOBP began in 2004 in collaboration with the COO.   The program, administered by UWSO, has continued to evolve and broaden its scope to bridge IOGs for practice across Canada.

The IOBP takes into consideration the candidates’ existing academic and clinical experience and optometric knowledge, provides bridging education, and prepares them for the provincial registration system such that they will be prepared to practice in Canada.

 

What is the pathway for internationally educated optometrists to become registered in Canada?

Pathways

 

*This includes a 3 year plus 1 pre-registration year (formal clinical placement in hospital or private practice with specific clinical milestones to be met).

** Candidate must be successful at each stage in order to proceed to the next step.

CEO = Canadian Examiners in Optometry

UWSO = University of Waterloo School of Optometry

 

What are the criteria for acceptance into the program and who sets them?

The criteria are reviewed and accepted by the Canadian Optometric Regulatory Authorities, CORA, on an annual basis. The minimum entry criteria have increased since the inception of the IOBP, based on reviews of program examination and CSAO results and recognition of the importance of accurately identifying academic, language and skill gaps.

The current application process assesses the applicants’ current level of the competencies required to practice in Canada as well as requiring a 4-year optometry degree and language competency.

There are 3 steps in the application process:

•     academic qualification/credential review
•     language requirements
•     prior learning assessment, which assesses current optometric knowledge, skills and judgment

Based on the results of these steps, applicants are :

•     offered admission into the Bridging One Program (short program)
•     offered admission into the Bridging Two Program (long program), or
•     refused entry.

Academic Qualification/ Credentials

Current applicants must:
1.    be currently licensed or registered (or eligible to be licensed or registered) to practice optometry in the country where their optometric education was completed, and
2.    have successfully completed either:
a.    3 complete academic years of full-time1 undergraduate university study prior to entering an optometry school and a 4 year optometry degree,2 or
b.    a 4 year optometry degree2 followed by 3 years of optometric work experience outside Canada

Footnotes
1.    Full-time means 5 courses per four-month term or semester with two terms per year.
2.    For the purpose of this application, the following is accepted as equivalent to a 4 year optometry degree:
A 3 year optometry degree followed by a pre-registration year/period and successful completion of the final assessment. This pre-registration year/period must be endorsed by the country in which they obtained your degree

Language fluency

A standardized test of language fluency must be completed if the applicants’ first language is not English.  The minimum accepted levels are noted below.

Test        Requirements
CLBPT    Minimum overall average of 8.0 with no individual scores lower than 8.0
              Centre for Canadian Language Benchmarks: Canadian Language Benchmarks Placement Test (CLBPT)
IELTS     Academic, minimum overall average of 7.5 with no individual scores lower than 7.0
             International English Language Testing System: Test Takers Information
CanTest  Minimum overall average of 4.5 with no individual scores lower than 4.0
              CanTEST, Official Languages and Bilingualism Institute (OLBI), Faculty of Arts, University of Ottawa: CanTEST

Applicants who just meet the minimum scores might find the program more difficult as it may be a challenge for them to understand, learn and speak optometry in English.

Prior Learning Assessment

The academic assessment community, including both CEO and NBEO, has previously identified that it is the measurement of competencies rather than adding up lecture hours that is the preferred way to assess preparedness for entry level examinations.

The Prior Learning Assessment (PLA) consists of both written and clinical skills components. The written component is developed and administered by CEO.  IOBP recognizes the experience of CEO in assessing competencies required to practice and an ability to accurately extrapolate the PLA results to success on the CSAO/CACO. The clinical PLA continues to be administered at the University of Waterloo using outside optometrist examiners and the CSAO protocol. The results of each individual are projected to the probability of success on the national board exams (CSAO/CACO) if the candidates went forward with no bridging.  This provides the IOBP with a clear picture of the academic and clinical gaps and therefore the level of bridging necessary for applicants.  Some applicants have gaps that are too large to bridge with this program and consequently not all applicants are offered a place in the bridging program.

In light of the changes in the CEO written entry to practice examinations introduced in 2011, IOBP administration has met with CEO to discuss changes to the PLA.   CEO, after consultation with IOBP staff, has increased the overall number of questions in the written PLA from 265 to 280:
•     120 optometric knowledge questions   
•     100 clinical judgment questions
•     60 ocular therapeutics questions

The clinical component is comprised of 4 skill sets requiring demonstration of optometric techniques in the areas of:
•     Interviewing, refraction and accommodation
•     Oculo-motor and sensory/integrative function
•     Ocular and systemic health assessment
•     Ophthalmic appliance assessment(spectacles and contact lenses)

Are candidates permitted to challenge the PLA more than once?

Candidates are allowed to re-sit the PLA once in recognition that there can sometimes be transient detractors from candidate performance (e.g., illness).  This approach is consistent with bridging programs for dentistry and more rigorous than for pharmacy and medicine. 

Does everyone who applies get into the program?

No. There are applicants, who do not meet entry standards at each stage of the application process (from academic credentialing through to the PLA).   Applicants must be successful at all stages of the application process to be accepted into IOBP. The program has assessed applicants from 144 educational institutions in 25 countries.  Students have been admitted from 75 of these institutions. 

Is there an admissions committee as there is for the Doctor of Optometry program at UWSO?

The admission process follows a set of criteria (e.g., defined standards for credentialing, language assessment and PLAs).  Due to the increasing number of applicants, the IOBP Advisory Committee approved moving to an Admissions Committee at the August, 2011 meeting.  Accordingly, meeting the minimum credentialing and academic entry criteria will not guarantee applicants a place in the program.

What does the Bridging Curriculum cover?

The Bridging One Program has been increased from the initial 2-week pilot program to the current 8-week program.  The program consists of 4 weeks on site at UWSO and 4 weeks in a private practice externship.  The students must pass 3 written exit examinations and a clinical examination.
The following provides a basic outline of the Bridging One curriculum:

    Classroom instruction :

  •     case analysis and case presentation
  •     ocular therapeutics and disease review
  •     profession-specific language skills
  •     communication skills for optometric practice
  •     cultural expectations in professional practice in Canada
  •     exam preparation (test-taking strategies, study skills, etc.)

    Clinical instruction:

  •     instruction and workshops in various clinical techniques
  •     use of ophthalmic equipment that is standard in Canada
  •     clinical instruction is reinforced by the use of interactive CDs on various optometric topics and procedures

    Externship placement

  •     a four week rotation of supervised patient care to expose the individual to Canadian optometric practices,   instrumentation and expectations.

The Bridging Two Program is a 48-week course with one term on site at UWSO, a one-term primary care externship and a one-term ocular disease externship.  Two classes of Bridging Two have now been completed and the third is in session. Curriculum has been updated to address increasing scope of practice. Bridging two students must be successful in 12 written exit examinations and a clinical exit examination.

The following provides a basic outline of the Bridging Two curriculum:

 3-week dedicated English Language Program:

  •     Administered and taught by the Renison University College English Language Institute
  •     integrated language skills that are profession specific
  •     disease description
  •     written documentation
  •     collegial consultation
  •     academic reading strategies
  •     language instruction continues throughout the 16 weeks of lectures

 16 weeks: lectures and clinical instruction in the following areas:

  •     learning strategies and exam-taking skills
  •     communication skills for optometric practice
  •     Canadian healthcare system jurisprudence
  •     ocular therapeutics and pharmacology
  •     ophthalmic and geometric optics
  •     ocular pathology/disease
  •     binocular vision
  •     problem-based case analysis and case management
  •     optometric procedures
  •     anatomy and physiology
  •     neurophysiology
  •    
  •     systemic disease
  •     contact lenses
  •     practice management
  •     low vision
  •     pediatrics
  •     interactive CD’s

4 weeks: UW Optometry Clinic Rotation:

  •      4 weeks in house at the School of Optometry patient clinic.

12 weeks: Primary Care Externship Rotation:

  •      supervised direct patient care providing candidates with exposure to optometric private practice in Canada.

12 weeks: Ocular Disease and Therapeutic Externship Rotation:

  •     supervised patient care focusing on ocular therapeutics and disease
  •     experience the diagnosis, treatment and management of ocular disease and ocular manifestations of systemic disease in an optometric/ophthalmologic clinical setting

1-2 weeks: Review and Examinations

  •         review and examinations throughout the program

Current initiatives include implementing online learning modules.

How is the program funded? 

There is ongoing funding from the Government of Ontario for the development and administration of this program.  Grants have also been received from the Government of Canada to develop a profession-specific language course in collaboration with the Renison University College English Language Institute. The tuition paid by the students covers the cost of delivering the program.  The program is revenue neutral for UWSO.

Who teaches in the program?

The instructors include a combination of full time and adjunct UWSO faculty.   To date, over 40 practitioners across Canada have volunteered their time as externship supervisors. 

Is there an Advisory Committee?

Typical of other bridging programas, the IOBP Advisory Committee is a component of the program’s governance structure.  The Ministry of Citizenship and Immigration has encouraged the participation of regulators, employers (practicing optometrists) and internationally educated professionals to facilitate the project meeting current requirements for registration and employment.  The Committee began meeting in 2009 on an annual basis; going forward, the committee will meet semi-annually. The most recent meeting was on August 25th , 2011 and the next meeting will occur in February 2012.

Current Advisory Committee Members

  • IOBP Director                  Dr. Murray Turnour

  • Interim Director, UWSO    Dr. Marlee Spafford

  • UWSO faculty                 Dr. Graham Strong

  • Appointed by COO           pending

  • External optometrist         Dr. Linda Bathe

  • External optometrist         Dr. Dagmar Lutzi

  • IOBP graduate                 Dr. Ibrahim Faruq

  • IOBP graduate                 Dr. Janelle King

  • Appointed by CORA         Dr. Robin Simpson

  • Secretary to Council         Deb Nahlik

The role of an advisory committee is to support the organization and complement the knowledge and skills of the formal administration by providing guidance and advice. Members are volunteers and agree to serve in an advisory capacity. The advisory committee makes recommendations and gives non-binding, but informed, guidance.

Specifically, the IOBP Advisory committee:

  • Promotes and supports the objectives and successes of the program and serves as an advocate for IOBP

  • Provides judicious advice regarding the program from various perspectives

  • Provides guidance and advice on all facets of the program

  • Recommends program enhancements for continuous improvements

  • Reviews current policies for fairness and transparency

  • Functions as a sounding board for the Director and staff of the IOBP regarding ongoing development

  • Attend an annual meeting and are available for consultation by email or teleconference through the year

Can the IOBP program be used as a shortcut by Canadian students to shortcut the time to become qualified through an ACOE-accredited school?

IOBP applicants must have a minimum of 3 years of undergraduate studies or 3 years of work experience as a licensed optometrist outside Canada. 
There are various reasons why students decide to seek their education overseas.  Canadian students are increasingly deciding to take professional degrees overseas; this trend has also been noted in medicine, dentistry, veterinary medicine and law.

Why does the profession not require an OD degree?

Like optometry, medicine, dentistry and pharmacy must consider that education and degree titles vary around the globe.  The Office of the Fairness Commissioner of Ontario stipulates that the process for internationally educated professionals is for both immigrants and Canadians that choose to be educated overseas.  The registration requirements must be the same for both groups.

Medicine accepts a Bachelor of Medicine/Bachelor of Surgery degree (MBBS) and dentistry accepts a Bachelor of Dental Surgery (BDS); the optometry equivalent is a Bachelor or Optometry or BSc Optom. In fact, medicine, dentistry and optometry are Bachelor’s degrees in the majority of countries around the world.

Why does the program accept ophthalmologists?

This policy was a continuation of the practice instituted by the College of Optometrists of Ontario prior to the inception of the IOBP.  In many countries, the profession of optometry does not exist and many ophthalmologists practice at the level of North American optometrists.  In China, for example, there are ‘refractive’ ophthalmologists, who do no surgery, and ‘surgical’ ophthalmologists.  There is no formal recognition of optometry in France, Greece, Turkey and numerous other countries

The current IOBP policy is that ophthalmologists who have completed a 3-year residency program can apply to the bridging program.  Preference is given to optometry applicants.

How do the IOBP students perform on the CSAO?

CEO defines success on the CSAO as passing all sections in 3 or fewer sittings.  Of the 167 IOBP registrants who have passed the CSAO, 159 or 95 % met the CSAO definition of success as presented above.   The first time pass rate is higher for registrants of the Bridging One program than for the Bridging Two program.   At the latest administration, 13 of 18 Bridging One registrants who sat for the first time passed all sections of the CACO for a first time pass rate of 72%(this is equivalent to the NBEO pass rate for the ACOE Inter-American School).

The pass rates have increased from 2005 and the program has been enhanced and the entry criteria increased. 
It should be noted that not all the candidates reported by CEO as IOGs over the past 5 years completed the IOBP.  IOGs were also from the following categories:

  •  A number had previously been deemed equivalent by the COO and had moved forward to the CSAO without completing the bridging program.
  •  Graduates of the Inter-American School in Puerto Rico, an ACOE-accredited school, where the students are educated in Spanish, were erroneously reported as IOGs until 2 years ago

What is the 2011 Enrolment?

Bridging One

  • February 2011 -- 20 students
  • May 2011 -- 20 students

Bridging Two

  •  June 2011 --class of 13 Will graduate in 2012

The IOBP/UWSO have committed to CORA that the enrollment will remain at 40 students annually.

 

How does the IOBP admission process compare to other health care professions?

The accompanying chart compares the current requirements for international optometric graduates to that of those for medicine, dentistry and pharmacy.
 
Optometry is the only profession of these 4 that requires undergraduate courses or work experience for internationally educated candidates.  The other 3 professions rely on their evaluating examinations in addition to a professional degree   to determine the current competencies of internationally educated applicants.  Optometry is also the only profession of the 4 that mandates a bridging program regardless of education and results of prior learning assessments.  The CSAO MCQ component has twice the number of questions of the qualifying examinations for both dentistry and pharmacy and 3 times as many as medicine.

See attached table (pdf) for the comparison of programs