Healthcare is primarily the domain of the provincial governments in Canada. The provincial optometry regulatory authorities are members of the Federation of Optometric Regulatory Authorities of Canada (FORAC). FORAC facilitates discussion, exchanging information, providing a national voice, and communicating with others about legislation, registration, standards of practice, continuing competence and any other issues related to the health care system. As such, FORAC has a specific interest in ensuring that the entry-to-practice requirements for optometry in each province are appropriate and consistent.
Labour mobility legislation in Canada permits an optometrist registered to practice in one province and move freely to another province without demonstrating evidence of academic or entry to practice exam registration requirements. When applicants utilize these labour mobility provisions, provinces differ in their requirements of evidence of practice in the jurisdiction where they initially registered. When provincial requirements vary, some candidates will choose the easiest path to registration and pay two sets of registration fees.
FORAC members accept the Canadian entry-to-practice examination, the Optometry Examining Board of Canada (OEBC) exam, for registration. However, some jurisdictions also accept the American exam, the National Board of Examiners in Optometry exam (NBEO), for registration. As a result, some candidates take the NBEO and are then able to register in Provinces that accept the US exam. This route to registration accounts for half of the annual registrants in some jurisdictions.
Most FORAC members are concerned that the US entry-to-practice exam is not equivalent to the Canadian exam. It is a significant concern since about half of Canada’s new optometrists are educated in the US.
In addition, the pass rates on the OEBC exam show a significant difference between those educated in Canada and those educated abroad. Graduates from US programs writing the Canadian exam underperform those from all other programs, as shown below in Table 1 – Pass Rates of First Time Writers of the OEBC Exam Components.
|OEBC Exam Pass Rates 2017-2021||Written Exam||Clinical Exam|
|Graduates from Canadian OD Programs||97%||91%|
|International Eye Care Professionals||89%||81%|
|Graduates from US OD Programs||87%||76%|
Table 1 – Pass Rates of First Time Writers of the OEBC Exam Components
In 2020 FORAC commissioned an independent expert report to determine if the concerns were valid. The University of Waterloo School of Optometry and Vision Sciences (WOVS) was awarded the project. The report concluded that the US exam is not an appropriate alternative entry-to-practice assessment for Canada.
A research paper based on the authors’ work was published in the Canadian Journal of Optometry in February 2022. The Abstract for the paper is below.
High-stakes assessments for entry-to-practice are critical tools used by the optometric profession’s regulatory bodies to assure safe, effective, and ethical practice by their respective registrants. In 2019, the College of Optometrists of Ontario approved the acceptance of the United States (US) entry-to-practice examination for optometry, the National Board Examiners in Optometry (NBEO®), as an acceptable alternative assessment for the Canadian entry-to-practice examination, the Optometry Examining Board of Canada (OEBC). However, this decision was not unanimously supported in stakeholder feedback. In this paper, the development and structure of the two assessments are described. A global consensus framework is applied to identify the appropriateness of the assessments for Canada, and a similar change in entry-to-practice in the field of nursing is examined for contextual correlates. Although intrinsically satisfactory for their respective jurisdictions, the NBEO® does not appear to satisfy the critical criteria of validity, equivalency, and acceptability for Ontario or, more broadly, Canada. Cultural and systemic differences between the Canadian and US healthcare systems were also identified as additional barriers. Lastly, major future vulnerabilities for the profession lie in the availability of an entry-to-practice examination for both Anglophone and Francophone Canadians.
Read the full research paper by Drs. Woo, S., Hrynchak, P., & Hutchings, N. that was published in the Canadian Journal of Optometry – Winter 2022, p. 33–44 (English), and p. 45–57 (French)
About the Optometry Examining Board of Canada (OEBC)
Founded in 1995, the Optometry Examining Board of Canada develops and administers a common national examination on behalf of the provincial optometric regulatory bodies — its members. The organization delivers a psychometrically valid and defensible assessment to demonstrate entry-to-practice competence in optometry in Canada. Its bilingual examinations are developed and administrated by the profession and for the profession.