How much do you know about your health allies?

Delegate. It’s a common bit of advice on how to prevent physician burnout. But there are barriers to delegation, including not fully understanding the competencies of the people working alongside you. Teamwork. That’s another gem for good patient care, and another reason to understand an allied health professional’s training and scope of practice so your co-workers’ skills and expertise can be used to their full extent.Just like physicians, allied healthcare professionals have accredited educational programs designed to meet core competencies, regulated professional standards and scopes of practice, all overseen by various bodies in different jurisdictions.Here’s an update on the training of four allied health professions in Canada. While there are many healthcare professionals who work alongside physicians, these four are allowed to prescribe medicines in some jurisdictions.PharmacyDegree: PharmDDuration of training: four yearsPrerequisite: at least two years of an undergraduate degree with certain courses as prerequisites (i.e., chemistry); most students complete an undergraduate degree prior to acceptance.All 11 pharmacy programs in Canada are now a Doctor of pharmacy (PharmD) program. They’re all accredited through a national body, the Canadian Council for Accreditation of Pharmacy Programs.The program comprises both lecture-based learning in sciences, administration and ethics, and hands-on learning. The practice skills learning begins in a simulated environment in the first years of the program.“In those sessions, students can do anything from interviewing their patients for a medical history, to assessing a patient coming in with a question about an OTC medication, or talking to patients about chronic disease management,” explained Teri Charrois, associate dean of practice innovation and professor of teaching at University of British Columbia faculty of pharmaceutical sciences. The sessions are in alignment with what they are learning with their therapeutics courses. “That allows them to practice in a safe environment before going on their clinical rotations.”The hands-on learning includes practice experience on prescribing. “We go through full patient assessments and then what we focus on with the students is assessing for any red flags that require the patients to be referred to another healthcare professional,” Charrois said.The fourth year is spent entirely in clinical rotations. Students have a minimum of 40 weeks of clinical practice experience in a pharmacy setting, in addition to simulated learning. The practice experience takes place in a variety of settings, involving patients with a range of healthcare needs.“Our programs are termed ‘entry to practice’ so they’re not meant to be overly specialized. It’s all the same expectations of all the programs to reach certain outcomes,” Charrois said.Upon degree completion, candidates must pass the Pharmacy Examining Board of Canada exam (with an alternate exam in Quebec). Some might choose to do a post-graduate residency program where they are immersed in experiential learning for that year. In British Columbia, these programs are run by local health authorities or other bodies. For example, there’s the addiction pharmacy fellowship offered by the British Columbia Centre on Substance Use.Provincial and territorial pharmacy regulatory bodies require pharmacists to take continuing medical education to ensure they maintain their competency. If physicians ever have questions about a pharmacist’s knowledge or scope of practice, they just need to reach out and ask a pharmacist, Charrois said.Nurse practitionerDegree: Master’s degree or post-Master’s diplomaDuration of training: Two yearsPrerequisite: At least two years of clinical nursing experience as a registered nurse (length of time varies between programs, with the minimum number of nursing hours ranging from 3,510 to 4,500)Nurses come to a nurse practitioner’s program with significant experience, said Roger Pilon, a registered nurse practitioner for more than 27 years. Pilon is the director of nursing and vice-dean of the faculty of health sciences at Queen’s University in Kingston, Ont.All nine universities in Ontario offering the nurse practitioner master’s program offer the same curriculum, one that provides fundamentals of research, as well as education on roles and responsibilities. Other coursework includes advanced pathophysiology, pharmacology and therapeutics and an advanced health assessment and diagnosis course. All courses integrate case-based learning.The program enhances and develops diagnostic skills using a mix of techniques, including simulated patient encounters and clinical reasoning exercises. At Queen’s University, the program uses objective structural clinical examinations to run students through different scenarios. All of these are designed so “students learn to think systematically; they consider a range of possible conditions; they look at the evidence; they rule in or out diagnoses based on the history they’ve taken or the physical exam they’ve performed and any investigations they have ordered,” Pilon said.In Ontario, nurse practitioner students must complete a minimum of 700 clinical hours through their clinical courses. In some cases, students may request to do more or may be required to do more training. The clinical training occurs in placements over a variety of settings to, “ensure we have a breadth of experience,” Pilon said.Nurses who already have a master’s degree in a relevant area can take a post-master’s diploma.Nurse practitioner training is changing in Canada as all the programs move to a single entry into practice program. Up until now, nurse practitioners have graduated in one of a few specialty areas, such as primary care, pediatrics or adult practice (i.e., practice with focus on neurology, orthopedics, endocrinology or women’s health). Starting next year, all nurse practitioner candidates will sit the same exam. The exceptions are the two neonatal programs in Canada.Now, “Everyone will be trained in all ages, in all settings,” Pilon explained. Training will not just be in primary care, but also in acute settings, in-patient settings and out-patient settings, as of 2026. “We’ve all adjusted our program and learning competencies to meet the requirements that will be there in 2026.”The reason for the change is to improve portability of nurse practitioner credentials and training across Canadian jurisdictions. The focus on a single entry to practice will be similar to physician training, first general, then a specialization. “Our program is going to be kind of similar,” Pilon said. The difference is there are no formal residencies for specialization. Instead new nurse practitioner graduates can seek out a mentorship in their first practice or some employers will offer on-the-job training in specialty areas. The final practicum can also serve as a way to further specialize.The competency framework for nurse practitioner education in Ontario includes the roles of clinician, leader, advocate, educator and scholar; all building on existing registered nurse competencies and all similar to family physicians’ competencies.Provincial and territorial nursing regulatory bodies have information on the scope of practice and standards of practice for nurse practitioners. Nurse practitioners have required hours of continuing medical education and quality improvement projects, which can lead to further levels of expertise.MidwiferyDegree: Bachelor’s degreeDuration of training: Four yearsPrerequisite: High school diplomaWhile the prerequisite for McMaster University’s midwifery program is high school, the majority of applicants have post-secondary education, explained Liz Darling, director and assistant dean of the Midwifery Education Program and professor in the department of obstetrics and gynecology at McMaster University in Hamilton.Of the four-year-long undergraduate degree, two years are spent on clinical placements. By the time they graduate, students will have attended 60 or more births, Darling said. They do academic work at the same time as clinical placements. There’s a focus on all the complications that can arise in pregnancy and birth, so graduates “have an in-depth knowledge that’s specific to pregnancy, labour and the post-partum period.”The course-based learning provides a solid basis in the sciences, such as anatomy, physiology, pharmacology and other areas of life sciences related to reproduction.“They learn quite a lot about all the medications that are related to the scope of practice of midwives,” Darling said. They study basic pharmacology and in clinical practice they learn more on how to give those medications.What medications midwives can prescribe (or administer under physician or nurse practitioner directive) varies between jurisdictions, but at McMaster University and in other programs, students learn the full scope. For example, midwives are not able to administer the RSV vaccine to pregnant patients and/or nirsevimab to infants born in RSV season in all provinces and territories, but it was still integrated into the teaching curriculum. “Sometimes those regulations take a bit of time,” Darling said.In much of Canada, midwives aren’t able to practice to the same scope of practice as they’re able to internationally. “The profession has a body of knowledge that is bigger than what people are allowed to do in the jurisdiction where they are.”If there is a change of regulations to expand midwifery scope of practice, midwives will be prepared. “Just like physicians, midwives have a responsibility to ensure they have the adequate skills, knowledge and judgement in order to be able to do anything that they’re doing in their practice,” Darling said.McMaster is changing one aspect of their program, increasing the time students spend in midwifery practice. Previously, students had four placements in midwifery practices and two in interprofessional settings. Now, five placements are in midwifery practices and only one is in an interprofessional setting. McMaster offers a master’s degree in midwifery that focuses on leadership and research.As well as Canada’s six university-based midwifery programs, there are two community-based programs offered in three Indigenous communities in Canada. At the end of the programs, graduates can take the Canadian Midwifery Registration Examination.Physician assistantDegree: Bachelor’s degree or master’s degree, depending on the institutionDuration of training: Two yearsPrerequisite: varies by programPhysician assistant programs outside of the Canadian Armed Forces are relatively new to Canada, with some established only in the past few years.The University of Toronto, the Northern Ontario School of Medicine in Thunder Bay, Ont., and the Michener Institute of Education at the University Health Network in Toronto have teamed up to offer a bachelor’s degree (BScPA) to applicants who already have a minimum of four full-time semesters of undergraduate university education and more than 350 hours of healthcare experience (including volunteer roles). The program includes online courses for the first year, then a year of clerkship rotations, including 12 weeks of primary care and month-long rotations in emergency medicine, pediatrics, etc. Clerkships are both in Southern and Northern Ontario. McMaster University in Hamilton offers a similar program with in-class learning for the first year.The University of Manitoba created the original master’s of physician assistant studies (MPAS) program. Similar graduate programs are now also offered at the University of Saskatchewan in Saskatoon, Dalhousie University in Halifax and the University of Calgary. Admission requires a prior undergraduate degree with courses in anatomy, physiology and, at the University of Saskatchewan, Indigenous studies. The two-year course involves in-class lectures, simulated hands-on learning and a clerkship year comprising various clinical rotations. Most of the programs involve a research project.Physician’s assistants are also trained by the Canadian Armed Forces.Canadian physician assistant educators updated the competency framework in 2021. It outlines the “entrustable professional activities” that a physician assistant can provide. This includes taking histories, performing physical examinations and educating patients on procedures, disease management and other health promotion. In practice, a physician assistant’s duties are defined by the supervising physician. Physicians can even delegate physician assistants to prescribe medications. The Canadian Medical Protective Association has guidance for physicians working with a physician assistant.At the end of training, candidates take the Physician Assistant Certification Council of Canada exam. They must take continuing professional education to stay certified.International medical graduatesAll four allied health professions have protocols in place to ensure international graduates have appropriate competencies to practice in Canada.

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