Because of COVID-19, the Objective Structured Clinical Examination (OSCE), pharmacy students’ last hurdle before licensure, was cancelled less than two days prior to the time the examination had been scheduled to run this month. This is the second time the exam has been cancelled since the spring.

The cancellation has left pharmacy students without a clear path to licensure, causing some to demand alternative solutions. The exam typically involves both a written portion and several tasks, including interacting with a simulated patient, client, or other health care professional.

In a series of tweets, U of T pharmacy graduate student Michelle Wang called on several organizations, including the Leslie Dan Faculty of Pharmacy at U of T, the Ontario College of Pharmacists (OCP), and the provincial government, to help pharmacy residents stuck in limbo as they await licensure. 

Exam cancellation and student backlash

According to the Pharmacy Examining Board of Canada (PEBC), which offers the OSCE, facilitation restrictions became more stringent after Toronto public health officials ruled that the examination was a meeting, rather than an educational event. This ruling subjected the OSCE to more gathering restrictions. The PEBC also identified the roll out of the provincial government’s new COVID-19 response framework as another barrier. 

Attempts by the PEBC to clarify the exam’s educational nature were unsuccessful, forcing officials to cancel the exam planned for November 8 in Toronto. The examining board noted that exams were held in other locations in the province.

However, Wang pointed out that more could have been done to make sure that the exam took place. In an interview with The Varsity, she suggested that U of T could have hosted the event, and argued this could have helped in getting the examination designated as an educational event. 

“There’s been times when our whole class [has had] to do these mock OSCE final exam scenarios to pass our year. So they’re capable of doing 240 students in a 16-storey building. They have so many rooms, so much space — no one’s in that building right now.”

A U of T spokesperson wrote that the Leslie Dan Faculty of Pharmacy “explored serving as an exam site and started down the path of planning fall exams” but that “as the pandemic worsened, we learned that the exam could not be accommodated given the space requirements.” The spokesperson added that the faculty dean has unsuccessfully requested that the exam be deemed an educational activity.

Wang also noted that the PEBC could have moved its exams online, especially since the OSCE for pharmacy students requires less physical contact. “PEBC kept saying that they [couldn’t] make it virtual for security reasons, which I don’t understand, because other professions have done this as well… Pharmacists never touch their patients unless they’re giving a flu vaccine.”

She added that she’s disappointed that pharmacy regulatory bodies haven’t found a solution, given that professions who do more hands on work, like chiropractors and physiotherapists, were able to get licensed during the pandemic. 

Pharmacy graduate students also pay around $2,000 to take the PEBC exams. Wang suggested that money could be invested in technology infrastructure or software engineers to move the examination process online.

In an email to The Varsity, the PEBC wrote that “the need to ensure the security of the exam and fairness to all candidates” could get in the way of administering the exam. The board added that “a virtual OSCE would have high technology demands given the need for all participants, candidates, Standardized Patients, and assessors, to have computers and internet connectivity with sufficient speed.”

Compensation and conditional licensure

Wang and other graduate students have also asked the OCP whether it would be willing to grant conditional licensure so that they can be compensated as fully licensed pharmacists, who get paid more than pharmacy interns. “Pharmacies are so busy right now… these interns who’ve been helping out so much [get] paid a little bit more than minimum wage, practicing a full scope during this time,” she said. 

In her experience, many older pharmacists also started taking fewer shifts because of the COVID-19 pandemic, so much of the increased workload has fallen on younger pharmacists and interns.

Wang also argued that some Canadian programs are already accredited by the Associations of Faculties of Pharmacies of Canada (AFPC), which checks for many of the skills tested by the PEBC. Completing a program that meets AFPC-accreditation requirements could temporarily stand in for the OSCE.

Other provinces, such as Québec, Nova Scotia, and Manitoba, have either granted conditional licensure for pharmacy graduates given the unique circumstances of COVID-19, or don’t require pharmacy graduates to take PEBC examinations at all. In a tweet, Wang also pointed out that, according to the Pharmacy Act of 1991, pharmacy graduates can receive licensure from any examination approved by the council of the OCP.

“OCP, our regulatory body, and the provincial government, and [Toronto Public Health]… they’re really the decision makers that can say ‘we’re going to grant you immediate conditional licensure,’ ” Wang said when asked where the next step for a resolution might come from. 

The provincial government wrote to The Varsity that the Ministry of Health is “not involved in licensing pharmacists or graduates of pharmacy programs” and that it relies on the OCP to guarantee that pharmacy graduates are qualified for licensure.

A spokesperson for the OCP wrote that the college shares students’ frustrations and continues to work toward appropriate solutions, “including the potential for temporary emergency registration, or conditional licensure which will be discussed at an upcoming Board meeting.”

“Such emergency registration would be subject to the government’s approval and determination that it is necessary to ensure access to pharmacy services in the province is protected,” they wrote.