‘Does the system even want us?’– Fostering the resilience of internationally educated health professionals facing threat to their professional identity in Canada

Abstract

This article explores resilience as a psychosocial concept, focusing on the experiences of internationally educated health professionals (IEHPs) newcomers to Canada who face multiple barriers to their professional integration. Based on focus groups with 25 participants in the programme Fostering Canadian Integration for IEHPs: From Learning to Action, the research examines the protective role of transformative adult education on the personal, relational and social resilience of newcomer IEHPs. There are four main outcomes of transformative education showing a positive impact on IEHPs’ resilience: self-awareness, belonging to a learning community, fostering a positive mindset and cultivating a meaningful professional identity.

Keywords

Resilience transformative education internationally educated health professionals immigration integration adversity

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References

APA . (2014). Resilience. https://www.apa.org/topics/resilience

Bardin

(2013). L’analyse de contenu. Presses universitaires de France. https://doi.org/10.3917/puf.bard.2013.01

Bourgeault

I. L.

Neiterman

LeBrun

Viers

Winkup

(2010). Brain gain, drain & waste: The experiences of internationally educated health professionals in Canada. University of Ottawa. www.Healthworkermigration.com

Briciu

Ste-Marie

Langlois

(2024). Recovering a sense of agency through transformative learning for internationally educated medical professionals (IEHPs) in Canada. Journal of Transformative Education. https://doi.org/10.1177/15413446241296079

Carter

Boden

Peno

(2000). Transformative learning in healthcare and helping professions education: Building resilient professional identities. Information Age Publishing.

CIHI . (2024). Internationally educated healthcare professionals. https://www.cihi.ca/en/the-state-of-the-health-workforce-in-canada-2022/internationally-educated-health-professionals

Cranton

Taylor

(2012). Transformative learning theory: Seeking a more unified theory. In Taylor

Cranton

(Eds.), The handbook of transformative learning: Theory, research, and practice (pp. 3–20). Jossey-Bass.

Dahl

Nortvedt

Schrøder

Bjørnnes

A. K.

(2022). Internationally educated nurses and resilience: A systematic literature review. International Nursing Review, 69(3), 405–415. https://doi.org/10.1111/inr.12787

Goodfellow

Zohni

Kouri

(2023). “A missing part of me:” A pan-Canadian report on the licensure of internationally educated health professionals [Final Report]. National Newcomer Navigation Network. https://www.newcomernavigation.ca/en/our-tools/resources/documents/IENRecommendationReport.FINAL-EN-WEB.pdf

10.

Green

(2023). No ground: Disorientation as prerequisite for transformation. Journal of Transformative Education, 21(2), 190–206. https://doi.org/10.1177/15413446221105577

11.

Groeninck

Meurs

Geldof

Van Acker

Wiewauters

(2020). Resilience in liminality: How resilient moves are being negotiated by asylum-seeking families in the liminal context of asylum procedures. Journal of Refugee Studies, 33(2), 358–370. https://doi.org/10.1093/jrs/fez080

12.

Hoggan

(2016). Transformative learning as a metatheory: Definition, criteria and typology. Adult Education Quarterly, 66(1), 57–75. https://doi.org/10.1177/0741713615611216

13.

Johnson

Baumal

(2011). Assessing the workforce integration of internationally educated health professionals. Canadian Society for Medical Laboratory Science.

14.

Kalish

Kampa

(2021). Stressor appraisal as an explanation for the influence of extra-individual factors on psychological resilience. In Ungar Michael (Eds.), Multisystemic resilience (pp. 135–152). Oxford University Press.

15.

Kass

(2017). A person centered approach to psycho-spiritual maturation. Palgrave MacMillan.

16.

Kegan

(2000). What “form” transforms?: A constructive-developmental approach to transformative learning. In Mezirow

(Ed.), Learning as transformation: Critical perspectives on a theory in progress (pp. 35–70). Jossey-Bass.

17.

Kelaghan

(2010). Evaluation research. In Peterson

Baker

McGaw

(Eds.), International encyclopedia of education (pp. 150–155). Elsevier Science.

18.

Kerins

Smith

Phillips

E. C.

Clarke

Hamilton

A. L.

Tallentire

V. R.

(2020). Exploring transformative learning when developing medical students’ non-technical skills. Medical Education, 54(3), 264–274. https://doi.org/10.1111/medu.14062

19.

Lewin

L. O.

McManamon

Stein

M. T. O.

Chen

D. T.

(2019). Minding the form that transforms: Using Kegan’s model of adult development to understand personal and professional identity formation in medicine. Academic Medicine, 94(9), 1299–1304. https://doi.org/10.1097/ACM.0000000000002741

20.

Luthar

S. S.

Brown

P. J.

(2007). Maximizing resilience through diverse levels of inquiry: Prevailing paradigms, possibilities, and priorities for the future. Development and Psychopathology, 19(3), 931–955. https://doi.org/10.1017/S0954579407000454

21.

Luthar

S. S.

Cicchetti

Becker

(2000). The construct of resilience: A critical evaluation and guidelines for future work. Child Development, 71(3), 543–562. https://doi.org/10.1111/1467-8624.00164

22.

Mawani

F. N.

(2014). Social determinants of refugee mental health. In Simich

Andermann

(Eds.), Refuge and resilience: Promoting resilience and mental health among resettled refugees and forced migrants (pp. 27–50). Springer Science + Business Media. https://doi.org/10.1007/978-94-007-7923-5_3

23.

McClinton

Laurencin

C. T.

(2020). Just in TIME: Trauma-informed medical education. Journal of Racial and Ethnic Health Disparities, 7(6), 1046–1052. https://doi.org/10.1007/s40615-020-00881-w

24.

Mezirow

(2009). Transformative learning theory. In Mezirow

Taylor

E. W.

(Eds.), Transformative learning in practice: Insights from community (pp. 18–32). Jossey-Bass.

25.

Neiterman

Bourgeault

(2015). Professional integration as a process of professional resocialization: Internationally education health professionals in Canada. Social Science & Medicine, 131, 74–81. https://doi.org/10.1016/j.socscimed.2015.02.043

26.

Paul

Martimianakis

M. A. T.

Johnstone

McNaughton

Austin

(2017). Internationally educated health professionals in Canada: Navigating three policy subsystems along the pathway to practice. Academic Medicine: Journal of the Association of American Medical Colleges, 92(5), 635–640. https://doi.org/10.1097/ACM.0000000000001331

27.

Preston

Shields

Akbar

(2022). Migration and resilience in urban Canada: Why social resilience, why now? Journal of International Migration and Integration, 23(3), 1421–1441. https://doi.org/10.1007/s12134-021-00893-3

28.

Sawyer

Stukey

M. R.

(2020). Professional learning redefined: An evidence-based guide. Corwin.

29.

Seligman

M. E. P.

(2006). Learned optimism: How to change your mind and your life (1st Vintage Books ed). Vintage Books.

30.

Siegel

D. J.

(2017). Aware: The science and practice of presence. TarcherPerigree.

31.

Taylor

E. W.

(2009). Fostering transformative learning. In Mezirow

Taylor

E. W.

(Eds.), Transformative learning in practice (pp. 3–18). Jossey-Bass.

32.

Ungar

(2012). Social ecologies and their contribution to resilience. In Ungar

(Ed.), The social ecology of resilience: A handbook of theory and practice (pp. 13–30). Springer Books.

33.

Ungar

(2013). Resilience, trauma, context, and culture. Trauma, Violence, & Abuse, 14(3), 255–266. https://doi.org/10.1177/1524838013487805

34.

Ungar

(Ed.), (2021). Multisystemic resilience: Adaptation and transformation in contexts of change. Oxford University Press. https://doi.org/10.1093/oso/9780190095888.001.0001

35.

Wald

H. S.

(2015). Professional identity (trans)formation in medical education: Reflection, relationship, resilience. Academic Medicine: Journal of the Association of American Medical Colleges, 90(6), 701–706. https://doi.org/10.1097/ACM.0000000000000731

36.

Wald

H. S.

(2020). Optimizing resilience and wellbeing for healthcare professions trainees and healthcare professionals during public health crises - Practical tips for an ‘integrative resilience’ approach. Medical Teacher, 42(7), 744–755. https://doi.org/10.1080/0142159X.2020.1768230

37.

Wallace

B. A.

Shapiro

S. L.

(2006). Mental balance and well-being: Building bridges between Buddhism and Western psychology. American Psychologist, 61(7), 690–701. https://doi.org/10.1037/0003-066X.61.7.690

38.

Walsh

Owen

P. A.

Mustafa

Beech

(2020). Learning and teaching approaches promoting resilience in student nurses: An integrated review of the literature. Nurse Education in Practice, 45(2), Article 102748. https://doi.org/10.1016/j.nepr.2020.102748

39.

Walton-Roberts

(2022). Global migration, gender, and health professional credentials: Transnational value transfers and losses. University of Toronto Press. https://doi.org/10.3138/9781487531744

40.

Walton-Roberts

(2023). The future of healthcare work and the place of migrant workers within it: Internationally educated nurses in Ontario Canada during the COVID-19 pandemic. Journal of Immigrant & Refugee Studies, 21(1), 59–72. https://doi.org/10.1080/15562948.2022.2153393

41.

World Education Services . (2022). Addressing the underutilization of internationally educated health professionals in Canada: What the data does and doesn’t tell us. https://www.wes.org/ca/iehps/