REPORT TO COUNCIL – June 26, 2024.
Submitted by: Kelly Dobbin, Registrar and CEO.
Each quarter, in advance of the College’s Council Meeting, the Registrar-CEO prepares her Quarterly Report to assure the Council that the College operates effectively and achieves its strategic goals, and that the Registrar performs per the expected duties outlined in the Council’s Governance Policies.
The Registrar-CEO is accountable for the College’s performance in six main areas:
- Strategic Leadership and Direction Setting
- Development and Achievement of Goals
- Reputation and Relationship Management
- Financial Accountability and Management
- People and Organizational Leadership
- Council Governance and Engagement
Strategic Leadership and Direction Setting
Designated Drugs and Substances Regulation
On May 3rd, 2024, the Designated Drugs and Substances Regulation O. Reg 188/24 came into force, setting out a greatly expanded list of drugs and substances that midwives can prescribe and administer. Access to these new drugs and substances reduces the need for midwifery clients to seek care outside of midwifery for treatment that is within the midwifery scope of practice, which improves the quality and timeliness of care for clients.
In addition to new hormonal contraceptives, antibiotics, vaccines, and vitamins and minerals, which midwives may now prescribe and administer, the new regulation now permits midwives to prescribe and administer opioid analgesic medications in hospital settings on their own authority. This means that midwives will no longer have to obtain a physician’s order to administer these drugs for intrapartum pain management.
To prescribe and administer these controlled substances, midwives must complete specified education and training as outlined in the Registrar’s Policy on Controlled Drugs and Substances Education and Training. The College has also produced a Safe Prescribing and Administration of Controlled Drugs and Substances course, which may be used by midwives to fulfill the specified training requirement. This course reviewed the legislation and regulatory context around the new regulation, provided information related to the opioid crisis in Canada, and was approved by the Council in 2023.
Following a communication strategy developed by the College, members of the public and registrants were provided with online information on the College’s website once the Designated Drugs and Substances Regulation came into effect. In addition to email communications about the new regulation, midwives were also invited to attend webinars to connect with the College to review the new regulation. The College presented three webinars on May 23 and 24, to provide information to the following three groups: faculty and preceptors, general registrants, and lead midwives at hospitals. The webinars consisted of an overview of the new designated drugs and substances regulation changes from the old regulation, Frequently Asked Questions, and Q&A period, as well as the ability for participants to complete the College’s Safe Prescribing and Administration of Controlled Drugs and Substances course.
In addition to the communications that we sent to all registrants and the members of the public on our email list, we sent letters to the Registrars of the College of Physicians and Surgeons of Ontario, the College of Nurses of Ontario, and the Ontario College of Pharmacists. In these letters, we provided a high-level summary of the changes, and requested that they share information about the new regulation with their registrants. We also prepared a letter to hospital administrators that lead midwives can request from the College to share with their hospital leadership. These letters are intended to ensure that other health care providers are aware of the expanded list so that midwifery clients do not have to face unnecessary barriers in accessing new drugs and substances.
While the implementation of the new Drugs and Substances Regulation marks the culmination of many years of work by the College of Midwives of Ontario, we recognize that there is still more work to do to improve midwifery client access to therapies and treatments that fall within midwifery scope of practice. To that end, we will continue to work in collaboration with the Ministry of Health to achieve sustainable health care solutions for Ontarians who seek midwifery care, including the Council’s proposal for midwives to prescribe and administer any drug or substance per their scope.
Professional Misconduct Regulation
In 2017, after a public consultation, the College submitted amendments to the Professional Misconduct Regulation (that was last revised effective October 2009). The proposed changes better align with the language of other health colleges’ regulations to maintain consistent standards for health practitioners and avoid duplicating content already covered in the Regulated Health Professions Act, 1991 (RHPA) or the Code. Changes also include the use of gender-inclusive language. We are pleased to report that the new regulation was filed with the Registrar of Regulations as O. Reg 229/24 and will come into force on July 1, 2024 (see attachment). The College is revising the Professional Misconduct Guide to align with these changes. The Guide explains what is meant by professional misconduct and the acts of professional misconduct that fall under them. The College is also updating its Guideline on Ending the Midwife-Client Relationship to align with the revised wording of the provision related to this subject. While the revisions will not change the way midwives practice, we have a planned communication strategy in place to ensure midwives are sufficiently aware of the changes and the materials we developed to help them avoid acts of professional misconduct.
Laboratory and Specimen Collection Centre Licensing Act
Over the past several months, the Ministry of Health’s Laboratories and Diagnostics Branch has been in consultation with the College regarding proposed changes to the General Regulation 45/22 under the Laboratory and Specimen Collection Centre Licensing Act, 1990, that were submitted last year. The proposed changes to expand the list of laboratory investigations (including lab and point-of-care testing) authorized to midwives were posted to the Ministry’s Regulatory Registry for public consultation from April 10 to May 25, 2024. The Ministry received feedback from interested stakeholders and rightsholders and will engage with the College again once that feedback is considered. We are hopeful that the proposed changes proceed as they are in the public interest by increasing access to standard tests for midwifery clients and facilitating effective consultations with physicians where necessary.
Registration Regulation
We have no recent updates to provide regarding proposed changes to the Registration Regulation that was formally submitted to the Ministry in May 2023.
The Office of the Ontario Fairness Commissioner
Under the fair access legislation, all regulators are required to submit a Fair Registration Practices Report to the Office of the Fairness Commission (OFC) each calendar year. This year, the OFC launched a new OFC portal to enable regulators to input their 2023 data. The College submitted our Fair Registration Practices Report on June 12, 2023, and the report is available on our website.
Language Proficiency Policy
Immigration, Refugees, and Citizenship Canada has recently added the Pearson Test of English to its list of recognized language proficiency test. Additionally, the International English Language Testing System, already recognized by the College, now offers candidates the option to retake one individual section to improve their scores instead of retaking the entire test. The College is obliged to accept the tests that are approved under the Immigration and Refugee Protection Act (Canada). To align with this legal requirement, the Registration Committee recently updated the Language Proficiency Policy, ensuring that the College continues to comply with the law.
Pathways to Registration for Internationally Educated Midwives
The College is seeking ways to create more pathways and remove barriers to registration for internationally educated midwives. To this end, we are exploring various registration options tailored to support internationally educated midwives’ need for entry-to-practise:
- Orientation and Assessment Program
- We are pleased to announce that the second cycle of the pilot Orientation and Assessment Program (OAP) is now complete. The second cohort began the program last fall and completed the program at the end of April. Unlike a bridging program, the OAP is designed to evaluate whether an internationally educated midwife possesses the equivalent entry-level competencies necessary for safe practice in Ontario. The program does not offer education or training or serve as a substitute for a formal midwifery education program. One of the benefits of this program is that candidates can obtain the competency certificates required for registration and a general orientation to midwifery practice in Ontario.
Six candidates were initially enrolled in the second cohort. After completing the three online modules and assessment, all six were eligible to participate in the in-person intensive session held at our office.
Three candidates successfully completed the program and received the required certificates in the following areas: Emergency Skills, Fetal Health Surveillance, and Neonatal Resuscitation. The College greatly appreciated the support of the Association of Ontario Midwives in assisting us to deliver the Emergency Skills Workshop. The three remaining candidates will have the opportunity to remediate program components that they did not successfully pass during the summer months.
A total of 10 OAP candidates have now successfully passed the Canadian Midwifery Registration Exam (CMRE) and have either registered or are eligible to register with the College.
The College is currently reviewing lessons learned and data from the first two cycles to determine necessary adjustments before launching the third and final pilot project cycle approved by the Council.
- We are pleased to announce that the second cycle of the pilot Orientation and Assessment Program (OAP) is now complete. The second cohort began the program last fall and completed the program at the end of April. Unlike a bridging program, the OAP is designed to evaluate whether an internationally educated midwife possesses the equivalent entry-level competencies necessary for safe practice in Ontario. The program does not offer education or training or serve as a substitute for a formal midwifery education program. One of the benefits of this program is that candidates can obtain the competency certificates required for registration and a general orientation to midwifery practice in Ontario.
- International Midwifery Preregistration Bridging Program
- The Registration Committee has made a recommendation to the Council to recognize the Chang School of Continuing Education’s proposed International Midwifery Preregistration Bridging Program (IMPBP) in principle (please refer to the briefing note under Agenda item 11). If approved, the IMPBP would be a new route of entry for internationally educated midwives seeking registration in Ontario. Unlike the OAP, the program is designed to be a bridging program, focusing on training and learning support in addition to the assessment of competencies. The most notable feature of the IMPBP is the inclusion of the clerkship which would facilitate candidates in consolidating their learning into practice.
- The Registration Committee has made a recommendation to the Council to recognize the Chang School of Continuing Education’s proposed International Midwifery Preregistration Bridging Program (IMPBP) in principle (please refer to the briefing note under Agenda item 11). If approved, the IMPBP would be a new route of entry for internationally educated midwives seeking registration in Ontario. Unlike the OAP, the program is designed to be a bridging program, focusing on training and learning support in addition to the assessment of competencies. The most notable feature of the IMPBP is the inclusion of the clerkship which would facilitate candidates in consolidating their learning into practice.
- Competency-based Assessment Tool
- With the completion of the competency-based assessment tool, we are examining how to operationalize the tool for entry-to-practice, if appropriate. While initially designed to assess the readiness of former or inactive registrants to safely return to practice, the assessment inherently evaluates whether individuals possess entry-level competencies for safe practice. In other words, some IEMs may be able to expedite their registration process by successfully passing this assessment, resulting in bypassing the time and financial commitments associated with completing the 7–9-month OAP or IMPBP. Council can expect to see a recommendation by the end of this calendar year.
College Performance Measurement Framework
As previously shared with the Council, the 2023 College Performance Measurement Framework (CPMF) cycle ended on December 31, 2023, and our 2023 CPMF report was submitted to the Ministry and posted to our website by March 29, 2024. We are proud of this year’s report where we once again demonstrated compliance with the standards and reported on our continuous improvement efforts.
The Ministry of Health introduced the CPMF in 2020. The CPMF was developed by the Ministry in collaboration with health regulatory colleges, members of the public, and subject matter experts. The CPMF sets standards against which all Colleges are measured related to performance in executing our public interest mandate and highlighting practices related to regulatory excellence.
Unauthorized Practice of Midwifery
The College continues to receive information about the unauthorized practice of midwifery and conducts further inquiries into these reports as expected by our mandate. We have updated our website to include a new page which provides clear information to the public and midwives about the issue and our role. We have added a public advisory that includes names of individuals who have come to our attention and where the College has taken action. Notably, the College obtained a court order requiring an individual to cease and desist from performing the controlled act of managing labour or conducting the delivery of a baby and to cease and desist from advising persons with respect to their health in circumstances in which it is reasonably foreseeable that serious bodily harm may result from the treatment or advice or from an omission from them. To take action, we continue to rely on reports from the public, clients, midwives, other health care providers, and direct witnesses to the conduct.
Quality Assurance Committee – Prescribing Standard
The Prescribing and Administering Drugs standard was scheduled for review in 2023 but was extended into 2024 to accommodate any changes necessary arising from the new Designated Drugs and Substances Regulation which came into effect on May 3, 2024. In light of these changes and other key considerations, on May 26, 2024, the Quality Assurance Committee recommended rescinding the Prescribing and Administering Drugs standard. Please refer to Agenda item 10 for the public interest rationale on this proposal.
Development and Achievement of Goals
Strategic Priority 1: Regulation that enables the midwifery profession to evolve
National Collaboration on a Competency-Based Assessment Program
With the competency-based assessment tool now complete, the College has initiated the second phase of the project, focusing on three main activities:
- Conduct an environmental scan of accessible resources relevant to each Canadian competency for midwives, as approved by the Canadian Midwifery Regulatory Council in December 2020.
- Develop and pilot a decision matrix that links each competency with specific resources to address gaps in knowledge and skill. This matrix will assist the Registration Committee issue individualized plans to remedy any identified competency deficiencies.
- Recommend an implementation plan to feasibly launch the assessment tool in a manner that is accessible and fair for registrants.
The College has launched a Request for Proposals and is looking forward to receiving tenders from experts to conduct the work. The Registration Committee is expected to receive the environmental scan by this fall, followed by the decision matrix and implementation plan by their December 2024 meeting.
Strategic Priority 2: Effective use of data to identify and act on existing and emerging risks
Surveys
The College has issued a Request for Proposals to engage consultants to assist us with a survey of midwifery clients in Ontario.
Our request for proposals asks consultants to develop and frame the questions for a public opinion survey. When reviewing the proposed methods, we will be considering cost, reach, and accessibility to ensure that our survey reaches a diverse group.
The purpose of the survey, as outlined in our current strategic plan, is to establish baseline data that we can compare against in the future as we continue our work in the public interest. We expect the survey to be in the field by Q3.
Strategic Priority 3: Building engagement and fostering trust with the public and the profession
Student and New Registrant Engagement
We see improving our engagement with students and new registrants as a crucial element of achieving our third strategic priority, building engagement and fostering trust with the public and the profession.
The purpose of our Student and New Registrant Engagement Plan is to improve our engagement with students, applicants, and new registrants. Currently, College staff members attend Midwifery Education Program (MEP) courses annually and visit classrooms in years one through four. The presentations are designed to be relevant for the students in each academic year.
We are looking to improve upon these annual visits and demonstrate to students that their relationship to the College will be broader than annual registration and quality assurance reports – that our standards and guiding documents relate to their practice on a day-to-day basis.
To create our new plan, we consulted with students, new registrants, faculty, and preceptors to find out what is missing from our current engagement. Following these surveys, we have a better understanding of the tools for engagement that our target audiences would like to see us use.
- Recorded videos and webinars. Based on the results of the surveys, it would be most effective to create webinars that we can then record and post to the website. All audiences would like recorded videos to review in their own time. The College currently has plans to be more targeted with our webinars and should consider these three audiences when planning future webinars. As mentioned in this report, we piloted this approach with the webinars for the changes to the Designated Drugs and Substances Regulation.
- Classroom visits. Those who are currently engaged in the education programs (i.e., faculty, preceptors, and students) would like to see classroom visits continue. The College plans to continue classroom visits to Midwifery Education Program students and has sent an email to faculty members to update them on the new strategy.
- Sections on the website. We also heard that dedicated space on the website would be valuable to students and new registrants. The College is actively working to launch a new registrant centre on our website and is considering dedicated spaces for students, faculty, and preceptors.
- Guides and FAQ documents. New midwives would like to see guiding documents from the College. We will launch an email series for new registrants in their first year of practice to promote existing College resources for new midwives who may not have come across our materials before.
Reputation and Relationship Management
System Partnerships
The College continues to meet regularly with midwifery and regulatory partners to further our respective mandates and to achieve our strategic goals.
Meetings with the Health Profession Regulators of Ontario (HPRO) and its affiliated sub-groups including the EDI Network, Communications Committee, and Citizen Advisory Group Committee are attended by College staff. Please see the attachment on HPRO’s highlights of the past year.
We are a member of a network of health profession colleges and associations with drug prescribing authority in Ontario. Together we meet to explore ways to improve how the controlled act of prescribing is regulated, allowing for sufficient flexibility to address the changing environment of drug treatments while also protecting the public. A proposal for an improved regulatory framework for prescribing and administering drugs and substances is currently in development and will be shared with the Ministry in 2024.
College staff and Council Chair meet regularly with the Canadian Midwifery Regulators Council (CMRC) and its affiliated committees including the Canadian Midwifery Registration Exam Committee; the Registration Affairs Committee; the Equity, Diversity, and Inclusion Committee; the Professional Practice Committee; Pathways to Indigenous Midwifery Committee; and the Accreditation Council of the Canadian Association of Midwifery Education.
The Ontario Midwifery Strategy Council (OMSC) met recently to discuss the status of conversations on a third site for the Midwifery Education Program (MEP) and ongoing meetings on midwifery scope of practice between the College, the Association of Ontario Midwives (AOM), and the Ministry of Health.
The Council Chair and College Registrar attended the Association of Ontario Midwives’ (AOM) Ontario Midwifery Conference (OMC) in May. It was a terrific opportunity to learn about new research and program evaluation in the sector which helps inform our work at the College. In addition, we recognized the need for the College to have a presence at future OMCs to better achieve our strategic priority of building engagement and fostering trust with midwives. We will consider making proposals for next year’s conference on our new initiatives and program evaluations. The Council Chair, Vice-Chair (Professional), and College Registrar also participated in the Midwifery Sustainability Project Roundtable that followed the conference. A report from the Midwifery Sustainability Project will follow and, if made public, can be shared with the Council when received.
Webinars on the Changes in the New Designated Drugs and Substances Regulation
As reported above, in late May, the College held three webinars for midwives to share high-level information about the changes in the new Designated Drugs and Substances Regulation. We recently surveyed faculty and preceptors and heard that this group would like to see the College produce more targeted communications for faculty and preceptors, and we trialled this new approach with our webinars. The three webinars were targeted at faculty and preceptors, lead midwives at hospitals, and all interested midwives. For the three webinars, we had 430 RSVPs from midwives and 52 questions submitted in advance. We were able to group most of the questions from midwives into three categories: questions about funding, questions about opportunities for training, and questions about how to integrate these changes in the hospitals where midwives have privileges. In total, 290 midwives joined the webinars over the three sessions. We have also sent a recording of the webinar to all midwives with some additional questions and answers so that midwives who were not able to attend are still able to benefit from the information in the webinars.
On Call Newsletter
The College published our quarterly On Call newsletter on Tuesday, May 21, 2024. Our Spring 2024 newsletter is the first digital newsletter that the College has sent out, with an emailed summary and links to each story instead of requiring readers to read a multi-page PDF document. This issue included information on the new Designated Drugs and Substances Regulation, new practice advice, Council highlights, 30 years of regulated midwifery, and more.
Social Media Engagement
The College has recently invested more time and effort into our social media channels, especially in establishing our new LinkedIn profile. The increase in posting has led to an overall increase in engagement across our three channels: Facebook, X (Twitter), and LinkedIn. The most popular posts tend to be celebratory in nature (e.g., celebrating 30 years since the first birth attended by midwives in an Ontario hospital), or sharing information on recent developments in the sector (e.g., news about the changes to the Designated Drugs and Substances Regulation.)
Peer and Practice Engagements
The 2024 cycle of the Quality Assurance Program Peer and Practice Assessment concluded in March 2024. This year, eight assessors provided peer assessments for 80 randomly selected midwives registered in the General class. Ninety-nine percent of the selected midwives completed the assessment without further assessment required. One hundred percent of midwives were successful after further assessment. The College invited the assessors to a debrief following the completion of this year’s assessments and they shared their reflections on the assessor training, areas of the program which worked well, and ideas for program improvement. The College has implemented several simple changes, such as information that is shared with registrants on our website, as a result of the assessor debrief, and will continue to collaborate with the assessors to improve the program. The Peer and Practice Assessment continues to be an excellent opportunity to foster professional development among midwives. The College is thankful for the thoughtful engagement of so many midwives and peer assessors in making this year’s Peer and Practice Assessment cycle a success.
Financial Accountability and Management
2023-24 Audit and Financial Statements
The College has undergone our annual financial audit which was executed virtually in May and continued into June. On May 8, 2024, the Executive Committee met with the auditors via videoconference to ask questions and oversee the audit process. The Executive Committee reviewed the draft Financial Statements with the auditors on June 12, 2024 and will bring them forward to the Council for approval. Please refer to Agenda item 6.
Q4 Statement of Operations
The Q4 Statement of Operations was initially presented to the Executive Committee in May for informational purposes only, as adjustments from the audit were anticipated. The post-audit Q4 Statement of Operations was reviewed and approved by the Executive Committee on June 12, 2024 and is included in their report to the Council for your information. Please refer to Agenda item 9.
People and Organizational Leadership
Human Resources
Johanna Geraci, Director of Professional Practice and Policy has resigned from her position at the College. She has been on a one-year leave since September 2023. Johanna originally joined the College in 2015, and we extend our gratitude to her for her dedication, hard work, and expertise during her time at the College.
We are pleased to welcome Emma Hosein as the College’s new Governance Officer. Emma started with the College in May. She is joining us from CivicAction where she was leading the strategic development of programs aimed at supporting diverse rising leaders and fostering equitable communities. Emma has an Honours BA in Equity Studies and an MSc in Gender, Development, and Globalization, and brings a wealth of experience in program and stakeholder management.
Learning & Development
The College has developed an internal Learning and Development strategy and plan. The strategy will ensure that our learning goals and initiatives are aligned with our strategic and operational plans. The purpose of the plan is to guide and measure our learning goals and initiatives. Over the last quarter, the College staff have engaged in learning sessions on the following topics: data privacy, trauma-informed practices, conflict resolution, and 2SLGBTQIA inclusive environments.
Council Governance and Engagement
Consultations on College By-laws
The College launched 60-day public consultations on both the General By-law and the Fees and Remuneration By-law from Thursday, April 4, 2024, to Monday, June 3, 2024. Registrants and the public were advised by email when the consultation was launched and reminded on social media and in the College’s On Call newsletter during the consultation period. Forty comments were submitted for the consultation on the Fees and Remuneration By-law, and four comments were submitted for the General By-law. Please refer to Agenda item 9 for post-consultation recommendations.
Council Elections
The College launched the 2024 Council election nominations on April 2, 2024. We held two information sessions for midwives interested in putting their names forward for election on Tuesday, April 23. One session was for midwives from Indigenous, Black, and racialized communities and the second was for all interested midwives. We sent out reminders about the nomination period by email and on our social media channels.
We are pleased to advise that Alexia Singh, RM and Lynne-Marie Culliton, RM have been acclaimed to fill the two open professional member positions for the Council.
Alexia Singh is a Black-identified, registered midwife. Alexia has been registered since 2015 and is pursuing her Master’s degree in Midwifery at McMaster University. She has also worked as a sessional instructor for the Midwifery Education Program and continues to mentor racialized midwifery students in the community. Alexia has recently started a new adventure as the Clinical Lead at Ancestral Hands Midwives, a newly funded expanded midwifery care model that will be exclusively providing midwifery and reproductive care to people within the African, Caribbean, Black diaspora who reside in the GTA. This collaborative, interdisciplinary program will allow equity-deserving populations to access midwifery in a non-traditional way. A community midwife working with Oak Valley Health’s Alongside Midwifery Unit since its inception, Alexia is also happy to continue to contribute to her community as a casual hospitalist. Alexia is excited to be moving into her second term as a Council member and looks forward to continued learning and collaboration for the midwifery community in the public interest.
Lynne-Marie Culliton brings a wide range of experiences and a deep commitment to advancing midwifery care since 2002 and is excited to join the Council for the College of Midwives of Ontario.As a person with a disability, she brings a unique perspective to her work, advocating for accessibility and equity in maternal health services.Her invaluable contributions extend to rural areas, where she tirelessly champions maternal health initiatives, ensuring that people in underserved regions receive the highest standard of care. As a recent graduate with a Master’s in Midwifery and a career marked by dedication to inclusivity and innovation, she specializes in the expanded model of midwifery, offering comprehensive sexual and reproductive health care to diverse communities.
Council and Committee Training
In March 2024, Council and Committee members received Discipline and Fitness to Practice Committee training and two presentations on key concepts related to Trauma-Informed Care in Regulation and Compassionate Regulation from external experts in these areas. The trainings were well received, and the key learnings and take aways will be further discussed and applied at the June Council and Committee training. In addition, the June training will highlight governing in context including an overview and reminder of the College’s governance policies and guiding principles, as well as interactive sessions on actively engaging in the decision-making process.