Very well.
The Canadian Association of Schools of Nursing, or CASN, is seeking the support of stakeholder here today in order to find the best possible solution to maintain access to health care in French in francophone communities outside Quebec.
I will begin with a brief summary of the situation and steps taken to date to find solutions.
With your permission, I will continue in English so that members of the College of Nurses of Ontario can follow my comments.
There's evidence of low pass rates among francophone nursing students on the American entry-to-practice exam, and this is putting access to health care in French at risk in francophone communities outside of Quebec. It's also putting francophone nursing education at risk outside of Quebec. Many francophones who wish to become nurses are choosing to enrol in English programs because of concerns related to the exam. The issue has revolved around translation and a lack of preparatory resources. At my association, we have received many complaints about the translation. I understand that there have been some improvement, but this has been an issue.
The translation company is Geo Group Corporation translation services in Madison, Wisconsin. It does translations globally in multiple languages, primarily for commercial businesses. Their method is translation rather than adaptation. We've learned from federal translators and from psychometricians in Canada that adaptation is a rigorous, more specialized process, and it's recommended required for high-stakes exams in both languages, to ensure equity.
Unfortunately, although there have been improvements, I believe, to the existing translation, I understand that it's not really sufficient to ensure an equivalent exam. I think an important point to realize is that the translation is not a once and for all thing that happens. The exam questions are being continuously developed, continuously updated, and the exam test plan is being continuously updated. It's really not just a question of improving the existing translation, then, but of ensuring that there's a methodology going forward that ensures an adequate, equitable translation.
An adaptation is more expensive, I understand, than a basic translation, but it is what is used in Canada.
I want to mention also that another issue with this linguistic aspect, the translation, is that Canadians now form 20% of the panels developing test questions. The Americans are 80%, and there are 20% Canadians. The group excludes, however, any francophone with limited English abilities, because the work is done in English. This excludes francophone nurses from participating.
Returning to the second question, the lack of preparatory resources, there are multiple commercial resources available in English. The NCSBN, which is the organization that owns and sells the exam, offers commercial online prep courses and prep modules. Many of these resources are computer-based, they're sophisticated, and they are used extensively in schools in the United States and are now used extensively in anglophone schools across Canada.
We've just done an analysis of schools that have undergone accreditation in the last two years to see what use has been made of these preparatory resources, and it's large. They are used to evaluate students throughout the program. They are also used to replace some kinds of courses, so they're integrated into the curriculum.
With respect to solutions to date, we wrote to NCSBN requesting that the exam have the questions in both English and French, so that if a francophone student has difficulty understanding the French, they can refer to the English, and that would tip them off. That's often done in high-stakes exams in Canada.
We didn't get a response, but I have learned—and I believe this is correct, although I can't verify it—that their computer software doesn't allow for that function of toggling between languages. However, the high-stakes exam software that we use in this country does allow for that type of toggling between French and English.
The other thing we requested is that they make available preparatory resources in French. They wrote to us last June, I think, and said they were putting together a preparatory exam in French, and I understand they've been working on it. I don't know that it's out yet, but they have been working on that exam.
We do have a concern going forward. I think this will be helpful, but it will not be at the same level of sophistication as these commercial resources that are being used. Our concern in the future is that the exam does get revised. We have information that they're testing a new type of question, to test clinical judgment and this sort of thing. We predict that this will result in a lot more preparatory resources to help people understand those kinds of questions or answer these questions well, but will they be available in French? As we go forward, will there be commercial products available in French?
