Christine Landry, Manon Denis-LeBlanc, and Daniel Hubert
Research has shown that francophone minority populations across Canada are in poorer health (perceived and actual) than the anglophone majority.1 According to the 2021 census of the Canadian population, French Canadians are by far Canada’s largest minority, with 21.4% of Canadians reporting French as their mother tongue.2 A report published in 2021 by the Consortium national de formation en santé (CNFS) showed that pharmacists were the least accessible health care providers in Canada when it comes to offering services in French.3 The University of Ottawa and its Office of Francophone Affairs developed and is implementing a new undergraduate (entry-to-practice) Doctor of Pharmacy (PharmD) program to be offered in French starting in September 2023.
The objectives of this article are to describe the needs of the Canadian population for health care services offered in French by pharmacists outside of Quebec and to briefly introduce the new PharmD program that will be offered in Ottawa, Ontario.
As of 2022, there were 10 pharmacy programs in Canadian universities. Such programs are offered in English at 2 other Ontario institutions (University of Toronto, with about 240 students in 2022, and University of Waterloo, with about 120 students).4,5 There are no other pharmacy training programs offered in French in the province of Ontario. Current student enrolment for the English programs amounts to a total of 360 for this province, which had an estimated population of more than 14 million in 2022.6
Two pharmacy training programs are offered in French in Canada, both in the province of Quebec (Université Laval, with about 190 students, and Université de Montréal, with about 200 students).7,8 Given the total of 390 pharmacy students, enrolment in Quebec, which had an estimated population of more than 8.5 million in 2022,6 has been greater than enrolment in Ontario (before initiation of the new PharmD program).
Understanding health care challenges in French minority settings outside of Quebec was an important step in the development of the new PharmD program. A minority official language setting is defined as a situation where there is a potential significant demand for services in the French minority official language, the place of residence is a province or territory outside of Quebec, and the mother tongue or home language (spoken most often or on a secondary basis) includes French as a single response on the census questionnaire or in combination with another language.2 Educating future pharmacists has been an aspiration for the University of Ottawa since the early 1990s, and this was the university’s fourth attempt to create such a program. This time, the university learned from its previous experiences, several internal analyses, and a variety of external assessments with a view to demonstrating the need to train more bilingual pharmacists outside of Quebec.
Some of the findings of these background analyses are summarized below.
Research has shown that francophone minority populations across Canada are in poorer health (perceived and actual) than the anglophone majority.1 In addition, francophones in minority communities are generally older, less educated, and in a less favourable economic situation. A recent study showed that francophones who were treated by a French-speaking physician in Canada had 24% lower odds of death than those who received care from a non-French-speaking physician.9 For allophones, the results were even more striking, with 54% lower odds of death.9 Although language is not considered to be a determinant of health, it plays a key role with regard to access to health services, quality of care, and patient safety.
Over the past 25 years, considerable effort has gone into implementing health care training programs for francophones throughout Canada, but pharmacy has not benefited from this momentum. This situation could explain the fact that outside the province of Quebec, the proportion of pharmacists able to speak French is significantly underrepresented relative to other health care professionals. As noted above, the CNFS recently reported that pharmacists are the least accessible health care providers in Canada in terms of services offered in French outside Quebec.3 In Ontario, there is a maldistribution of French-speaking pharmacists, which may limit the ability of francophone patients to receive pharmacy services in their preferred language.10 In that study, the distribution of pharmacists was assessed in relation to the larger concentration of the francophone population, geography (north versus south), and community type (rural versus urban), and was found to vary according to each of these characteristics.10
In several provinces and territories, the pharmacist’s role has evolved in recent years to include a broader range of primary care services not limited to vaccination. For example, in recent months, Ontario and Yukon have expanded pharmacists’ scope of practice to include prescribing medications for common minor ailments.11,12 In these jurisdictions, the patient can now look to the pharmacist to receive treatments that, in the past, would have been provided by a physician or other health care professional. Pharmacists have become an integral component of the continuum of care, which leads to the need for more training resources.
In addition to many changes in the pharmacist’s scope of practice, the demand for pharmacists is expected to increase in the coming years because of population growth, aging of the population, the increasing complexity of health care, the development of new drugs, and an increase in the number of medications prescribed.
These factors, as well as existing data consulted in the course of planning for the new program and certain data collected specifically to assess pharmacy services available in French, all support the current and future need for French-speaking pharmacists in Canadian francophone minority communities.
Overall, estimates based on the 2021 census of Canada demonstrate the need for an additional 750 French-speaking pharmacists in Canada outside of Quebec by 2026.2 The training of pharmacists in French in Ontario will help to address the challenge of offering pharmaceutical services and care in French, mitigating anticipated pharmacist shortages and making the profession more accessible to the francophone minority population.
Following work to better understand needs and interest, a team of experts (including pedagogical specialists, pharmacists, faculty members, and external representatives) was set up to develop the program in its entirety. Training will be adapted to local needs and will focus on various innovative educational elements. For example, this new undergraduate pharmacy program will be the first in Canada based on entrustable professional activities (EPAs). The EPAs were further broken down by competency, aligned with both the 2017 educational outcomes of the Association of Faculties of Pharmacy of Canada (AFPC) 13 and the 2014 professional competencies for Canadian pharmacists at entry to practice of the National Association of Pharmacy Regulatory Authorities (NAPRA).14 Teaching methods will be based on active and experiential learning, planned formative and certificative assessment, and integrated interprofessionalism. The curriculum design will follow a spiral pedagogical method. The 2 main goals of a spiral curriculum are building continuity from one year to the next in all areas of study (vertical integration) and building interrelationships among these disciplines (horizontal integration). Integration helps create a schema that allows for effective teaching of complex and higher-order thinking skills, which in turn facilitates the development of proficiency in problem-solving abilities that are not usually addressed by a traditional curriculum.15
Starting in September 2023, the new undergraduate PharmD program offered at the University of Ottawa will train 60 students per cohort per year who will be able to practise as pharmacists in various inpatient and outpatient care settings. This program, offered in French, is aimed primarily at francophones from Ontario, as well as francophones from elsewhere in Canada, with the objective of meeting the need for bilingual pharmacists in minority settings.
In addition to meeting the standards of practice set by 2017 AFPC educational outcomes and 2014 NAPRA entry-to-practice competencies,13,14 a PharmD graduate from the University of Ottawa will have the following skills and abilities:
Studies have shown that the health of the francophone population in minority settings across Canada is poor, with limited access to services affecting the quality of care. Of all health care providers, pharmacists are the least accessible to offer pharmaceutical care and services in French outside of Quebec. The training of bilingual pharmacists is key to addressing these challenges and better serving the population. The new pharmacy program at the University of Ottawa will be the only undergraduate PharmD program in Canada based on EPAs and will have the main objective of meeting the need for increased accessibility of pharmaceutical care and services by bilingual pharmacists in minority settings across Ontario and Canada as a whole.
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2 Census of population [2021]. Statistics Canada; [cited 2022 Dec 30]. Available from: https://www12.statcan.gc.ca/census-recensement/index-eng.cfm
3 Diaz Pinsent Mercier Research Inc. Accès aux services en santé dans la langue officielle de leur choix par les minorités francophones hors Québec. Analyse de données secondaires. Consortium national de formation en santé; 2021 May 3 [cited 2022 Dec 30 ]. Available from: https://cnfs.net/wp-content/uploads/2021/06/DPM-Acc%C3%A8s_services_en_sant%C3%A9_langue_officielle_minorit%C3%A9s_francophones_hors_Qu%C3%A9bec_Rapport_3mai2021.pdf
4 Programs: Doctor of Pharmacy (PharmD): Frequently asked questions [webpage]. University of Toronto, Leslie Dan Faculty of Pharmacy; [cited 2022 Dec 30]. Available from: https://www.pharmacy.utoronto.ca/programs/doctor-pharmacy-pharmd/frequently-asked-questions#:~:text=Approximately%20240%20students%20are%20admitted%20to%20the%20PharmD%20program%20each%20year
5 Pharmacy: Future students: Doctor of Pharmacy (PharmD) [webpage]. University of Waterloo, School of Pharmacy; [cited 2022 Dec 30]. Available from: https://uwaterloo.ca/pharmacy/future-students/doctor-pharmacy-pharmd
6 Ontario population 2022 [webpage]. [cited 2022 Dec 30]. Available from: https://canadapopulation.org/ontario-population/
7 Faculté de pharmacie: Doctorat de 1er cycle en pharmacie [webpage]. Université de Montréal, Faculté de pharmacie; [cited 2022 Dec 30]. Available from: https://admission.umontreal.ca/programmes/doctorat-de-1er-cycle-en-pharmacie/#:~:text=Le%20Pharm.,annuelle%20est%20de%20200%20%C3%A9tudiants
8 Faculté de pharmacie: Programmes: Doctorat de premier cycle en pharmacie [webpage]. Université Laval; [cited 2022 Dec 30]. Available from: https://www.pha.ulaval.ca/etudes/programmes/doctorat-de-premier-cycle-en-pharmacie
9 Seale E, Reaume M, Batista R, Eddeen AB, Roberts R, Rhodes E, et al. Patient–physician language concordance and quality and safety outcomes among frail home care recipients admitted to hospital in Ontario, Canada. CMAJ. 2022;194(26):E899E908.
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10 Timony PE, Waite N, Houle S, Violette R, Gauthier AP. The pharmacist is in: the availability and distribution of French-speaking pharmacists in Ontario. Minor Linguist Soc. 2022;18:175–96.
11 Government of Yukon expands services for pharmacists to include prescribing [news release]. Government of Yukon; 2022 Dec 28 [cited 2022 Dec 30]. Available from: https://yukon.ca/en/news/government-yukon-expands-services-pharmacists-include-prescribing
12 Expanded scope of practice: minor ailments. Ontario College of Pharmacists; 2022 [cited 2022 Dec 30]. Available from: https://www.ocpinfo.com/practice-education/expanded-scope-of-practice/minor-ailment/
13 AFPC educational outcomes for first professionnal degree programs in pharmacy in Canada 2017. Association of Faculties of Pharmacy of Canada; 2017 Jun [cited 2022 Dec 30]. Available from: http://www.afpc.info/system/files/public/AFPC-Educational%20Outcomes%202017_final%20Jun2017.pdf
14 Professional competencies for Canadian pharmacists at entry to practice. National Association of Pharmacy Regulatory Authorities; 2014 Mar [cited 2022 Dec 30]. Available from: https://napra.ca/wp-content/uploads/2022/09/NAPRA-Comp-for-Cdn-PHARMACISTS-at-Entry-to-Practice-March-2014-b.pdf
15 Dowding TJ. The application of a spiral curriculum model to technical training curricula. Educ Technol. 1993;33(7):18–28.
Competing interests: None declared.
Funding: None received.
Acknowledgements: For their support in the creation of the program described here, the authors thank the University of Ottawa PharmD Working Group (Pierre Moreau, educational consultant and past dean of pharmacy, Kuwait University; Pierre Giguère, pharmacist; Daniel Figeys, director of the new School of Pharmaceutical Sciences, University of Ottawa; Patrick Leclair, family physician practising in a minority setting and director of the Health and Wellness Clinic, University of Ottawa; and John Leddy, professor in the Faculty of Medicine, University of Ottawa) and the Office of Francophone Affairs, Faculty of Medicine, University of Ottawa.
Canadian Journal of Hospital Pharmacy, VOLUME 76, NUMBER 4, Fall 2023