Study of Registration Practices of the
COLLEGE OF MIDWIVES OF ONTARIO, 2007
- 1. INTRODUCTION
- 2. BACKGROUND OF THE REGULATORY BODY
- 3. REGISTRATION PRACTICES
- a. Registration Requirements and Application Process
- b. Documentation Required from Internationally Trained Individuals
- c. Credential Assessment (Third Party and/or Internal)
- d. Academic/Program Requirements
- e. Work Experience Requirements
- f. Examinations
- g. Language Requirements
- h. Fees
- i. Third Parties
- j. Typical Length of the Registration Process
- k. Accredited Programs
- l. Internal Review/Appeal Process
- 4. BRIDGING PROGRAMS
- 5. MUTUAL RECOGNITION AGREEMENTS
- 6. APPLICANTS’ INTERACTIONS WITH REGULATORY BODY
- 7. CHANGES SINCE THE 2005 SURVEY
- 8. REGISTRATION INFORMATION AND STATISTICS
- 9. SOURCES
ISBN 978-1-4249-6462-8 [HTML English version]
1. INTRODUCTION
The Office of the Fairness Commissioner (OFC) undertook a study of registration practices of Ontario's regulated professions during the fall and winter of 2007–2008. The purpose of the study was to understand each regulated profession's 2007 registration practices and to establish baseline data and information to enable the OFC to measure progress as it fulfills its mandate under the Fair Access to Regulated Professions Act, 2006.
This report reflects the registration practices of the College of Midwives of Ontario as of December 31, 2007. Information in this report was gathered from
face-to-face meetings with registration staff of the regulatory body
additional documentation provided by the regulatory body
relevant websites
career maps for the profession posted on the Ministry of Citizenship and Immigration's website (where applicable).
The College of Midwives of Ontario also provided registration information and statistics for 2005, 2006 and 2007 through a standard spreadsheet designed by the OFC.
An analysis and summary of the findings for all of the regulated professions are contained in the OFC's Ontario’s Regulated Professions: Report on the 2007 Study of Registration Practices.
2. BACKGROUND OF THE REGULATORY BODY
a. Legislation
The College of Midwives of Ontario (CMO) operates in accordance with the Regulated Health Professions Act, 1991 and the Midwifery Act, 1993.
b. Protected Titles
Midwives in Ontario are regulated by the CMO. Individuals cannot practise midwifery, use the title “midwife” or hold themselves out to be such unless they are registered with the college.
c. Definition of the Profession
According to the Midwifery Act, 1993, "the practice of midwifery is the assessment and monitoring of women during pregnancy, labour, and the postpartum period and of their newborn babies, the provision of care during normal pregnancy, labour, and postpartum period, and the conducting of spontaneous normal vaginal deliveries."
Midwives in Ontario are primary caregivers. As such, they hold full legal responsibility for their clients and are not supervised by a physician or obstetrician. Midwives in Ontario never work in only one area of client care, such as prenatal or intrapartum care. They are required to provide full service to their clients in all trimesters, throughout labour and birth and for six weeks postpartum. Under normal circumstances a midwifery client and her newborn do not see any other health care practitioner during this time. All midwives must attend both home and hospital births. Midwives are required to hold admitting privileges in at least one hospital and to attend a minimum number of both home and hospital births per year to maintain their registration.
d. Labour Market/Economic Trends
Demand for midwifery services is high across the province. The shortage of family doctors and specialists in Ontario has led to an increase in the demand for midwives.
Ontario’s Ministry of Health and Long-Term Care allocates the funding for midwifery practices. While there is no guarantee of immediate employment, new registrants are usually able to find work, although they may have to relocate to a community where a midwifery practice has an opening.
Midwives work full-time or part-time, although they must work full-time for their first year of registration. Currently, there are close to 400 midwives working in Ontario, with approximately 40 new registrants joining the profession each year.
e. New Developments Within the Profession
The number of registrants with the CMO has grown significantly in 14 years. The Ministry of Health and Long-Term Care announced an expansion of the baccalaureate education program that will almost double in the next seven years the number of midwives enrolled.
The CMO has requested an amendment to the Midwifery Act to implement a registration exam as a non-exemptible requirement. The regulation has not yet been passed.
f. Staffing
The CMO staff consists of seven full-time employees and one part-time employee. Two out of the seven employees are involved in the registration process.
3. REGISTRATION PRACTICES
a. Registration Requirements and Application Process
An applicant is defined as an individual who completes an educational program in midwifery, submits an application form and pays the application fee to the college.
i. Basic Requirements for Registration
The requirements for registration are:
proof of completion of acceptable midwifery education
attendance at 60 births
current certification in cardiopulmonary resuscitation (CPR), obstetrical emergency skills (ES) and neonatal resuscitation (NRP)
proficiency in either French or English
membership with the Association of Ontario Midwives (AOM)
professional liability insurance
having no criminal convictions
not being under disciplinary action by another regulatory body
proof of Canadian citizenship, landed immigrant status or open employment authorization.
ii. Classes of Registration
There are three classes of registration with the College of Midwives of Ontario: General, General with Conditions, and Supervised.
General
Registrants in the General class practise with no restrictions on their registration.
General with Conditions
Graduates of the Ontario Midwifery Education Program (MEP) are registered in the General with Conditions class. The college’s New Registrants Policy states that for the first year of practice, all new registrants must practise within an established Ontario practice, must work full-time and must attend births with an experienced midwife. Other than these conditions, the new registrant is like any other midwife in the province, and provides the full scope of midwifery care. Once the conditions of this policy have been met, the member’s registration class is changed to General.
Supervised
Graduates of the International Midwifery Pre-registration Program (IMPP) are registered in the Supervised class. The supervision is imposed to enable the supervised midwife to meet the clinical birth numbers required by the college’s registration regulation, as well as to make up any gaps in clinical skills identified during the International Midwifery Pre-registration Program.
Supervised midwives are fully registered members of the college and provide the full scope of midwifery care to their clients. They are paid at the same rate as all other new registrants. Supervision is for a minimum of three months but will typically last anywhere from six to 12 months. The supervised midwife has an individualized supervision plan prepared by the college prior to registration. Once the supervision plan is complete, the member’s registration class is changed to either General with Conditions or General, depending on whether the midwife is still in her new registrant’s year. A supervised certificate may only be issued for 12 months or less.
iii. Steps in the application process
Step 1 – Submission of Application
Application forms are provided by a CMO representative to MEP and IMPP students as part of their course materials. Midwives who wish to apply under reciprocity from another Canadian province must contact the college for an application form.
The completed application form is submitted to the college along with the following documents.
for MEP graduates: a transcript and clinical record; proof of current certification in CPR, ES and NRP; proof of ability to work in Canada; photo identification; two passport photos; and post-dated cheques to cover registration fees
for IMPP graduates: a copy of the IMPP final report and clerkship requirement form; proof of a passing grade in the Ontario Midwifery Language Proficiency Test (MLPT); proof of current certification in CPR, ES and NRP; proof of ability to work in Canada; photo identification; two passport photos; and post-dated cheques to cover registration fees
for applicants who are general registrants in another province of Canada: a letter of professional standing from their regulatory body; proof of current certification in CPR, ES and NRP; proof of ability to work in Canada; photo identification; two passport photos; and post-dated cheques to cover registration fees.
Step 2 – Review of Application
Applications are reviewed to determine whether they are complete. Applicants are contacted and informed of any missing information or documentation.
Step 2a – Supervision Plan (for IMPP graduates only)
When an application for an IMPP graduate is received, the college prepares an individual supervision plan for the applicant. This plan addresses both deficiencies in clinical hours and any gaps in clinical skills identified by the IMPP. A supervising midwife is designated. The applicant and all members of the practice she will be working with during her supervision must sign this supervision plan. The IMPP graduate’s application is not complete until the college receives the signed supervision plan.
Step 3 – Association of Ontario Midwives (AOM) Membership and Insurance
Once the application is complete, the college contacts the AOM to verify that the applicant is a member of that organization and that the applicant’s liability insurance has been arranged.
Step 4 – Registration
Upon receipt of verification from the AOM of both membership and insurance, the college issues a registration number and processes the registration documents. The new member may now begin providing midwifery services.
b. Documentation Required from Internationally Trained Individuals
i. Standard Documentation
Before applying to the college for the provincial licence, internationally trained midwives must attend the International Midwifery Pre-registration Program offered by Ryerson University. The IMPP is the only route to registration and practice in Ontario for internationally educated midwives. Applicants are required to submit their documents and information to IMPP. The documentation will be used to conduct a competency assessment.
The IMPP uses World Education Services (WES) to verify documentation related to midwifery education. Applicants must provide evidence of graduation from an accredited midwifery program.
ii. Options for Applicants with Unavailable/Destroyed Documents
The IMPP sometimes has candidates who do not have access to transcripts or certifications. The IMPP's policy is that the program may use alternative methods of establishing that the candidate is a midwife, including written submissions by the candidate, other references where possible and, most critically, an in-person assessment of clinical competencies through an Objective Simulated Clinical Exam and by written exam, prior to entrance.
c. Credential Assessment (Third Party and/or Internal)
The CMO does not perform any type of internal credential assessment. It relies on the IMPP for credential assessments of internationally trained midwives. The IMPP conducts competency-based assessments.
d. Academic/Program Requirements
The requirement to have completed acceptable midwifery education is satisfied with proof of graduation from an approved midwifery program. Approved programs include:
Ontario Midwifery Education Program (MEP), a four-year baccalaureate degree offered at Ryerson University, Laurentian University and McMaster University
International Midwifery Pre-registration Program (IMPP) offered at Ryerson University
Baccalaureate degree program in midwifery from another province in Canada.[1]
In addition, applicants must be currently certified in CPR, ES and NRP. CPR and ES certification must be within the previous 24 months; NRP certification must be within the previous 12 months. The standard for NRP is the Heart and Stroke Foundation of Canada, the standard for CPR is Basic Rescuer Level C, and the standard for ES is the Association of Ontario Midwives’ ES workshop, Advances in Labour and Risk Management (ALARM), Advanced Life Support Obstetrics (ALSO) or Managing Obstetrical Risk Efficiently (MORE OB).
e. Work Experience Requirements
To be registered with the college, an applicant must have attended 60 births: 40 as a primary midwife, 10 home births and 10 hospital births. Continuity of care (prenatal, intrapartum and postnatal care) must have been provided in 30 of the 60 births.
The MEP enables its students to attend 60 births within the program. Internationally trained midwives are credited with 20 births, in recognition of their previous work experience, and must attend 40 births in the IMPP.
Internationally trained midwives are provided with a supervision plan upon completion of the IMPP. Applicants receive a report of their clinical clerkship so that any clinical hour deficiencies or gaps can be addressed during their supervised practice.
All internationally trained midwives come with practical clinical experience, obtained either in the workplace or during the clinical placement component of their education. At point of entry and throughout the first term of the IMPP, internationally trained midwives participate in written and clinical exams of midwifery competencies. These exams determine whether internationally trained midwives can move directly to a clinical placement and final exam (fast tracking) or whether they require a second term of courses in clinical knowledge and skills enhancement and professional communication before moving on to the clinical placement and final exam.
f. Examinations
Currently there is no registration examination; however, it is expected that a standardized national registration examination, the Canadian Midwifery Registration Examination (CMRE), will become a non-exemptible requirement for registration starting in May 2008. The CMRE is a seven-hour multiple-choice exam with no clinical component and was developed based on the Canadian Competencies for Midwives set by the Canadian Midwifery Regulators Consortium (CMRC) and the College of Midwives of Ontario (CMO).
The CMRE will be offered twice a year in Ontario, British Columbia, Manitoba, and Alberta. The registration examination will be offered in one location in each participating province except Ontario and Manitoba, where second sites will be offered to take into account northern midwifery education programs.
As of 2008, all applicants for midwifery registration in regulated jurisdictions (except Quebec) will be required to take and pass the CMRE. (The exam will be implemented in Quebec if and when legislation allows.) Candidates may choose to take the exam in English or in French. A “blueprint” of the exam, a list of reference materials and study tips are available on the CMRC website.
g. Language Requirements
The CMO does not administer any language proficiency tests. The Midwifery Language Proficiency Test (MLPT) is fully administered by the IMPP; it tests the reading, writing, and listening skills needed in order to practise as a midwife in Ontario. The test is profession specific, is available in English and French and is offered four or five times per year.
Applicants must achieve a score of 70 per cent in each of the four sections of the MLPT in order to register with the CMO.
The MLPT is offered and available to any internationally educated midwife; it is not necessary to be registered in the IMPP to take the test. Once a midwife has registered to take the test and payment has been received, a complete sample test is sent.
h. Fees
|
College application fee |
$50 |
|
College membership – annual fee[2] |
$1,500 |
|
Administration fee – annual |
$35 |
| Additional Fees | |
|---|---|
|
International Midwifery Pre-registration Program [3] (payable to Ryerson University) |
Approximately $4,900 |
|
Ontario Midwifery Language Proficiency Test (MLPT)[4] |
$195 |
|
Association of Ontario Midwives fees |
$1,100 to $2,300 |
|
Canadian Midwifery Registration Examination (CMRE)[5] |
$750 |
i. Third Parties
| Name of Third Party | Relationship to Regulatory Body |
|---|---|
|
International Midwifery Pre-registration Program (IMPP) |
Provides a bridging program for internationally trained midwives |
|
Association of Ontario Midwives |
Provides required liability insurance to members |
|
Canadian Midwifery Regulators Consortium (CMRC) |
Administers the registration exam starting May 2008. |
j. Typical Length of the Registration Process
For applications that are complete, the registration process takes between two and four weeks. There is a two-year time limit for the application process starting from the completion of the education program. When the Canadian Midwifery Registration Examination (CMRE) is implemented, the two-year period will start after the applicant has written the exam.
k. Accredited Programs
The Ontario Midwifery Education Program (MEP) is a four-year baccalaureate degree offered at three Ontario universities: Ryerson University, Laurentian University and McMaster University. In Canada, there are six accredited programs including these three in Ontario. The others are baccalaureate degree programs in Quebec, British Columbia and Manitoba.
l. Internal Review/Appeal Process
The CMO’s registration appeal process was developed in accordance with and to meet the requirements of the Regulated Health Professions Act. A proposal by the Registrar to refuse to issue a licence to an applicant must be referred to the Registration Committee.
The Registration Committee is composed for three professional members and two public members.
If the Registration Committee directs the Registrar to refuse to issue a registration, or to impose terms, limitations or conditions on a registration, the applicant can appeal to the Health Professions Appeal and Review Board (HPARB). Registration decisions are issued in writing to the applicant and include reasons for the decision. Applicants can access all the information concerning the decision with respect to their case.
The information about appeals of decisions will be made available on the CMO’s website.
The IMPP assesses midwives within the framework of the courses offered at Ryerson University. Students who want to appeal their course results must use the university’s appeal process.
4. BRIDGING PROGRAMS
The International Midwifery Pre-registration Program (IMPP) is operated by a consortium made up of Ryerson University’s G. Raymond Chang School of Continuing Education, College of Midwives of Ontario (CMO), and Ontario Midwifery Education Program (MEP). The program is funded by the Ontario Ministry of Citizenship and Immigration, Labour Market Integration Unit.
IMPP is a nine-month part-time bridging program. It is the only route to registration and practice in Ontario for internationally educated midwives. It provides:
skills assessment
information about how midwives practise in Ontario
clinical placements
mentoring
final pre-registration exam
The IMPP is intended for experienced internationally trained midwives, fluent in English, who have practised midwifery within the past five years. On average, 25 candidates are enrolled per year.
5. MUTUAL RECOGNITION AGREEMENTS
Currently, the CMO has a mutual recognition agreement with British Columbia, Manitoba, Alberta, Northwest Territories and Quebec.
6. APPLICANTS’ INTERACTIONS WITH REGULATORY BODY
a. Nature and Frequency of Communication
The CMO has frequent contact with applicants throughout the registration process. In addition, the college makes presentations about registration to midwifery students in Ontario.
b. Backlogs
Currently there is no backlog in the registration process.
c. Complaints Regarding the Registration Process
Dissatisfaction with the registration process is addressed by the college in the following ways: applicants are provided with further explanation of registration decisions, information about opportunities to appeal decisions is provided, feedback about the registration and renewal processes is noted and taken into account during departmental reviews.
7. CHANGES SINCE THE 2005 SURVEY
The Ministry of Citizenship and Immigration conducted a survey in 2005 to collect information about occupational regulatory bodies in Ontario.
Since that time a career map was developed in collaboration with the Labour Market Integration Unit, Ontario Ministry of Citizenship and Immigration. In addition, a certification in Obstetrical Emergency Skills (ES) was added as a registration requirement. A document containing the Canadian Competencies for Midwives was developed between the CMO and CMRC.
8. REGISTRATION INFORMATION AND STATISTICS
Definitions used in these tables:
Alternative class of licence: a class of licence that enables its holder to practise with limitations; additional registration requirements must be met in order to be fully licensed. Alternative classes of licence granted by the College of Midwives of Ontario are specified under the tables below
Applicant: an individual who has applied to start the process for entry to the profession.
Applicant actively pursuing licensing: an applicant who had some contact with the College of Midwives of Ontario within the year specified.
Inactive applicant: an applicant who had no contact with the College of Midwives of Ontario within the year specified.
Member: an individual who is currently able to use the protected title or professional designation of “midwife.”
| Language | 2005 | 2006 | 2007 |
|---|---|---|---|
| English |
Yes |
Yes |
Yes |
| French |
No |
No |
No |
| Other(s) |
|
|
|
| Applications received | 2005 | 2006 | 2007 |
|---|---|---|---|
| Largest number |
N/A |
N/A |
N/A |
| Second-largest number |
N/A |
N/A |
N/A |
| Third-largest number |
N/A |
N/A |
N/A |
| Fourth-largest number |
N/A |
N/A |
N/A |
| Fifth-largest number |
N/A |
N/A |
N/A |
| Number of staff | 2005 | 2006 | 2007 |
|---|---|---|---|
| Involved in registration process |
2 |
2 |
2 |
| Involved in appeals process |
2 |
2 |
2 |
| Members | Ontario | Other Canadian Provinces | USA | Other International | TOTAL |
|---|---|---|---|---|---|
| Total members |
310 |
7 |
N/A |
89 |
406 |
| Non-practising members |
30 |
0 |
N/A |
6 |
36 |
|
|
Jurisdiction where members were initially trained in midwifery (before they were granted use of the protected title or professional designation in Ontario) | ||||
|---|---|---|---|---|---|
| In 2005 (Jan. 1 to Dec. 31) | Ontario | Other Canadian Provinces | USA | Other International | TOTAL |
| New applications received |
37 |
2 |
N/A |
10 |
49 |
| Applicants actively pursuing licensing |
37 |
2 |
N/A |
10 |
49 |
| Inactive applicants |
0 |
0 |
N/A |
0 |
0 |
| Applicants who met all requirements and were authorized to become members but did not become members |
0 |
0 |
N/A |
0 |
0 |
| Applicants who became members |
37 |
2 |
N/A |
10 |
49 |
| Applicants who were authorized to receive an alternative class of licence but were not issued a licence1 |
0 |
0 |
N/A |
0 |
0 |
| Applicants who were issued an alternative class of licence1 |
0 |
0 |
N/A |
10 |
10 |
1 The alternative class of licence was Supervised Class.
|
|
Jurisdiction where members were initially trained in midwifery (before they were granted use of the protected title or professional designation in Ontario) | ||||
|---|---|---|---|---|---|
| In 2006 (Jan. 1 to Dec. 31) | Ontario | Other Canadian Provinces | USA | Other International | TOTAL |
| New applications received |
38 |
2 |
N/A |
11 |
51 |
| Applicants actively pursuing licensing |
38 |
2 |
N/A |
11 |
51 |
| Inactive applicants |
0 |
0 |
N/A |
0 |
0 |
| Applicants who met all requirements and were authorized to become members but did not become members |
0 |
0 |
N/A |
0 |
0 |
| Applicants who became members |
38 |
2 |
N/A |
11 |
51 |
| Applicants who were authorized to receive an alternative class of licence but were not issued a licence1 |
0 |
0 |
N/A |
0 |
0 |
| Applicants who were issued an alternative class of licence1 |
0 |
0 |
N/A |
11 |
11 |
1 The alternative class of licence was Supervised Class.
|
|
Jurisdiction where members were initially trained in midwifery (before they were granted use of the protected title or professional designation in Ontario) | ||||
|---|---|---|---|---|---|
| In 2007 (Jan. 1 to Dec. 31) | Ontario | Other Canadian Provinces | USA | Other International | TOTAL |
| New applications received |
49 |
0 |
N/A |
9 |
58 |
| Applicants actively pursuing licensing |
49 |
0 |
N/A |
9 |
58 |
| Inactive applicants |
0 |
0 |
N/A |
0 |
0 |
| Applicants who met all requirements and were authorized to become members but did not become members |
0 |
0 |
N/A |
0 |
0 |
| Applicants who became members |
49 |
0 |
N/A |
9 |
58 |
| Applicants who were authorized to receive an alternative class of licence but were not issued a licence1 |
0 |
0 |
N/A |
0 |
0 |
| Applicants who were issued an alternative class of licence1 |
0 |
0 |
N/A |
9 |
9 |
1 The alternative class of licence was Supervised Class.
9. SOURCES
Canadian Midwifery Regulators Consortium website: http://cmrc-ccosf.ca/node/23. Last accessed: January 22, 2008.
College of Midwives of Ontario website: http://www.cmo.on.ca/default.asp. Last accessed: January 22, 2008.
College of Midwives of Ontario and Ministry of Citizenship and Immigration. “Access to the Midwifery Profession in Ontario.” Ministry of Citizenship and Immigration website. http://www.citizenship.gov.on.ca. Last accessed: January 22, 2008.
International Midwifery Pre-registration Program website: http://ce-online.ryerson.ca/ce_2007-2008/program_sites/program_gateway.asp?id=2161. Last accessed: January 23, 2008.
Representatives of the College of Midwives of Ontario met with staff of the Office of the Fairness Commissioner on December 10, 2007, to provide further information for this study.