Entry to Practice Standards and Continuing Competence

Those involved in the initial licensing/registration/credentialing process deal with the issues, trends, and challenges of playing the "gatekeeper" role that is fundamental to professional regulation, outside of the testing and examination realm. Topics may include defining competencies within a scope of practice, setting standards of qualification (education, training, experience), establishing equivalencies, assessing practical experience, accrediting education providers, artificial barriers to practice, labor mobility (national and international), appeals processes when registration is denied, when should the bar be raised or lowered, re-entry to practice scenarios, etc. 

Webinar Recordings

Previous webinar topics related to testing and examinations will be available for purchase in CLEAR's new store soon. Expand the sections below for more information on available webinar recordings.

On July 9, 2020, Michigan Governor Gretchen Whitmer issued Executive Directive 2020-7, which requires the Department of Licensing and Regulatory Affairs to promulgate administrative rules requiring all health care professionals to receive training on implicit bias and the way it affects the delivery of health care services. The rules are intended to establish implicit bias training standards as part of the knowledge and skills necessary for licensure, registration, and renewal of licenses and registrations of health professionals in Michigan. This webinar will provide an update on this initiative including stakeholder outreach efforts, content of the proposed rules, and remaining procedural steps prior to implementation.

Originally presented: February 2021

Marlon Brown, Director, Policy & Legislative Affairs, Michigan Department of Licensing and Regulatory Affairs

The Pennsylvania Department of State conducted a year-long study on the effects of occupational licensure for veterans and military spouses. As part of the study, the Department surveyed over 200 veterans and military spouses, seeking their feedback on topics such as license portability, barriers to licensure, and the overall license application process. Findings from this research led to the development of policy recommendations targeted at creating more employment opportunities for this population while simultaneously increasing the number of qualified professionals practicing in Pennsylvania.

Originally presented August 2021

Andrew LaFratte, Executive Policy Specialist for the Pennsylvania Department of State

Nursing regulatory colleges frequently receive questions about the roles of licensed practical nurses (LPN), registered nurses (RN) and registered psychiatric nurses (RPN) in specific practice settings. In today’s complex health care environment the answer to this question is multifaceted and requires the consideration of several factors.

In order to address the scope of practice of three nursing professions the registrars of the three nursing regulatory colleges in Manitoba came together to collaborate on a solution. The conclusion of this work is a principle-based document that provides a framework for employers that truly provides for each profession to practice to their full scope of practice: "Nursing in a Team Environment."

The session will discuss how the three regulators put aside long-held beliefs about rigid professional boundaries and collaborated to find a new approach. The registrars used the collaboration competencies from the National Interprofessional Competency Framework (2010) as a framework to guide their discussions as well as the Nursing in a Team Environment Document. The approaches used by the three registrars to establish a common understanding about scope of practice and the intersection between the three nursing professions will also be discussed.

An innovative approach was used to develop both a model for assessment of team composition and a care continuum. The model for team composition assessment begins with determining the population health needs and culminates with client need. This considers the broad scope of health services that are required to provide safe, competent care that is required. The care continuum takes into account the context of care, the practice setting and amount of available support to the health care team and patient needs. These two models are brought together to provide appropriate care to the assessed needs. Questions based on the National Interprofessional Competency Framework competencies are included for employer consideration as they apply the frameworks. The document was tested by practice and education leaders to determine its efficacy in real life situations and is currently being utilized in a concerted effort to optimize the scopes of practice of all members of the health care team during the pandemic.

Learning objectives:

1. Attendees will learn how three nursing regulators used the National Interprofessional Competency Framework to reconceptualize boundaries between their professions

2. Attendees will learn about a model for assessment of team composition

3. Attendees will learn about regulators contribution to the health system

Originally presented: August 2021


Deb Elias, Chief of Quality Practice, College of Registered Nurses of Manitoba
Ryan Shymko, Practice Consultant/Deputy Registrar, College of Registered Psychiatric Nurses of Manitoba
Brenda Wohlgemuth, Education Programs Evaluations Consultant, College of Licensed Practical Nurses of Manitoba

Internationally trained immigrants and refugees stand ready to contribute their valuable education and experience to the United States workforce. Yet, obtaining licensure in the U.S. can be a time-consuming, complicated, and expensive process, especially in highly regulated fields like health care, engineering, and education. In 2016, the U.S. Department of Labor (DOL) funded a consortium of states to study occupational licensure issues and identify best practices and solutions to policies that create unnecessary barriers to labor market entry for disproportionately affected populations, including immigrants.

World Education Services (WES), in collaboration with the National Conference of State Legislatures (NCSL), the Council of State Governments (CSG), and the National Governors Association (NGA), is facilitating discussions among eight states on how to update licensure requirements to address barriers to licensure and create alternate pathways to licensure. These discussions also serve to highlight best practices and model policies aimed at reducing certain occupational licensing barriers and building more equitable licensing frameworks.

This session will cover the preliminary findings of the working group. Presenters will share:

  • Best practices on how to approach and access licensure reform
  • Strategies that can be used by states seeking to create more inclusive workforces

Originally presented October 2021


Mike Zimmer, Senior Policy Consultant, World Education Services (WES)

Anne Head, Commissioner, Maine

Mona Siddiqui, Senior Policy Advisor, Virginia

Kit Taintorm, Senior Advisor for New American Integration, Colorado

The CPA Evolution initiative is transforming the CPA licensure model to recognize the rapidly changing skills and competencies the practice of accounting requires today and will require in the future. It is a joint effort of the National Association of State Boards of Accountancy (NASBA) and the American Institute of Certified Public Accountants (AICPA). As part of the CPA Evolution initiative, the leadership of NASBA and AICPA determined that the Uniform Accountancy Act Model Rules around educational requirements for licensure needed to be updated to incorporate additional subjects and skills reflective of the evolving profession and create more consistency. The new model includes an emphasis on the impact of technology and a focus on topics new hires need to know to align with employers’ needs. Hear from Dan Dustin, NASBA’s vice president of state board relations, about why a new model was needed, the process to develop the new model, and getting buy-in for the new model.

Concepts and topics discussed during the webinar will be applicable beyond the accounting profession, as all regulators face similar challenges of addressing rapid changes in technology and competencies required of the future licensee.

Dan Dustin
, Vice President, State Board Relations, National Association of State Boards of Accountancy

Originally presented April 2022

Professionals are required to conduct themselves in a manner that is appropriate and consistent with the written and unwritten standards of their profession. Professionalism can be demonstrated in the way a professional executes both their clinical skills and their soft skills. Soft skills, which include behaviours that relate to communication, ethical conduct and leadership, are recognized to have an impact on how the patient/client perceives the professional, as evidenced for example, in patient satisfaction surveys. It is increasingly evident that soft skills (or gaps in these skills) are related to patient complaints and subsequent disciplinary actions by regulators.

The College of Registered Psychotherapists of Ontario (CRPO) recognizes that psychotherapists rely on soft skills to establish and manage effective therapeutic relationships. Indeed, a defining competency of the psychotherapy profession – safe and effective use of self – relies on highly developed soft skills in order that the competency can be performed consistently even in challenging conditions.

We will share a continuing competence assessment methodology that highly emphasizes soft skills, explaining how this transfers to interview-based, written, and case-based examinations.

Learning Objectives
1. Recognize the value of assessing soft skills in continuing competence.
2. Explore a step-by-step process for creating soft skills assessment tools that provide members/candidates with formative feedback.
3. Apply this methodology to a case-study conducted by CPRO.

Originally presented: October 2018


Lene Marttinen , Manager, Quality Assurance, College of Registered Psychotherapists of Ontario

Leanne Worsfold, Director, Quality Programs and Test Development, iComp Consulting Inc.

Two regulators will discuss their experience with cultural competency, safety and humility in healthcare.

Encouraging Cultural Competence: Oregon’s Approach - The modern physician’s oath includes a promise to not allow “considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor” to interfere with the patient relationship. At the same time, disparities exist among population groups in both health and access to care. The Oregon Medical Board sought to support its licensees in becoming more culturally responsive and providing compassionate care to all patients. The Oregon Medical Board’s proactive and educational approach to this important issue resulted in the award-winning publication, Cultural Competency: A Practical Guide for Medical Professionals.

Cultural Safety and Humility in Health Care: a BC Regulator’s Journey - An extensive residential school system set up in 1870 by the Canadian government and administered by churches had a devastating long-term impact on the lives of Aboriginal people. To this day, Aboriginal people experience worse health outcomes, including shorter life expectancy, higher suicide rates and higher prevalence of chronic disease, than other Canadians as a result of systemic racism in the health system. In 2017, British Columbia’s 21 health regulators made a written pledge to the First Nations Health Authority declaring their commitment to cultural safety and humility in the health system. Dr. Heidi Oetter, registrar and CEO of the College of Physicians and Surgeons of BC, will share one regulator’s journey towards building awareness about cultural safety in health service delivery and implementing cultural humility in regulatory proceedings and day-to-day operations.

Originally presented: March 2019


Nicole Krishnaswami, Executive Director, Oregon Medical Board

Heidi M. Oetter, Registrar and CEO, College of Physicians and Surgeons of British Columbia

New research from the University of Waterloo studied non-urgent emergency department visits in Ontario and found that nearly one-third of such visits could have been managed by pharmacists with expanded scope of practice. The report notes that expanded scope for pharmacists in community practice or based in the Emergency Department could reduce crowdedness in EDs and allow for more ED resources to be devoted to care for more acute patients.

Webinar objectives:

  • Provide an overview of expanded scope of practice for pharmacists in Canada
  • Give a summary of previous research studies that assessed the proportion of unnecessary emergency department visits in Canada and previous research studies that estimated the potential impact of expanded scope of practice on emergency department visits
  • Present the methods and results of a retrospective quantitative population-based observational cohort study performed in Ontario, Canada to: (1) Determine the proportion of avoidable ED visits that can potentially be managed by pharmacists within an expanded scope, (2) Determine the most prevalent conditions within these cases; and (3) Determine the factors associated with presenting to EDs with a case that is manageable by pharmacists.

Originally presented: May 2019


Wasem Alsabbagh, Assistant Professor, School of Pharmacy, University of Waterloo

Michael Dugan and Eric Fish with Federation of State Medical Boards will describe work that FSMB is doing related to blockchain technologies and portable credentials. Through the use of blockchain technology, FSMB is enabling the use of trustless verification to reduce the cumbersome and time-consuming nature of multiple parties verifying the same information. Learn about promising blockchain technology pilot programs helping to drive future advances in regulation.

Originally presented: July 2019


Michael Dugan, Chief Information Officer, Federation of State Medical Boards

Eric Fish, Senior Director of Legal Services, Federation of State Medical Boards

This webinar will explore how the UK’s General Medical Council (GMC) has been focusing on “upstream regulation,” early interventions that aim to prevent harm, as opposed to acting “downstream,” once harm has already occurred. GMC colleagues will explain some of the theory that informs their approach before sharing practical examples of what they are doing. This includes identifying risks by different cohorts of doctors and providing supportive teaching interventions to help them deliver the standards set in Good medical practice.

Originally presented: October 2019


Tista Chakravarty-Gannon, Regional Liaison Adviser, General Medical Council

Kim Tolley, Regional Liaison Service, Training Development Manager IGPR General Medical Council

This session will describe the journey of developing and implementing professional competencies in a regulatory context with an emphasis on cultural competence. Information will be presented from the occupational therapy boards of New Zealand and Australia. Each presentation will identify the catalyst for focusing on cultural competence of the jurisdictions and look at how competencies have been developed for regulatory use. The presenters will describe where they are on the journey and conclude with a view of the next steps. The session will have particular application for regulators who require registrants to demonstrate competence in delivering safe health services.

Originally presented: January 2020


Julie Brayshaw, Board Chair, Occupational Therapy Board of Australia
Andrew Charnock, CEO and Registrar, The Occupational Therapy Board of New Zealand