Assessing the Effectiveness of Bridging Programs for Internationally Educated Physiotherapists in Canada

Abstract

Background: Physiotherapists are regulated allied health professionals whose broad scope of practice encompasses the assessment, diagnosis, prognosis, and management of movement dysfunction and physical impairment. They play a substantial role in clinical medicine, and their work is grounded in evidence-based medicine and the principles of the applied sciences. Despite their importance in our health care system, workforce shortages for physiotherapists are being felt across Canada, with projected shortages of licensed physiotherapists worsening in the coming decades (Watson et al., 2026). An important source of new physiotherapists is the integration of internationally trained physiotherapists. A common integration pathway is through bridging programs, which support internationally educated physiotherapists (IEPTs) in adapting to the Canadian healthcare context. Developed in the late 1990s, bridging programs have been associated with smoother transition experiences and have provided useful educational inputs that improve graduates’ knowledge and skill levels (Austin & and Rocchi Dean, 2006; Chiang et al., 2024a; Johnson & Israel, 2011). However, much of the available research literature on bridging programs focuses on professions other than physiotherapy, or includes only a limited number of physiotherapist respondents, or prioritizes quantitative designs. As a result, in-depth qualitative research examining how bridging programs function for internationally educated physiotherapists remains limited. Consequently, the specific barriers IEPTs face and the form of support most likely to facilitate their successful integration remain poorly understood. Research on bridging programs for internationally educated physiotherapists remains limited, even though these professionals provide essential treatment and rehabilitation to patients across a wide range of clinical settings throughout the country. This gap warrants focused investigation, particularly inquiry directed at strengthening the training of newcomer physiotherapists, enhancing their professional knowledge and building confidence as they move on the pathway to registration. While much of the broader literature focuses on immigrant physicians and nurses, less attention has been directed to other allied health specialties, especially physiotherapists. Moreover, commonly reported indicators of program success (e.g., exam pass rates or employment) can miss the qualitative dimensions that shape the experiences, professional identity, and adaptation of bridging program graduates. This proposed study fills an important gap by exploring the lived experiences of IEPTs and how bridging programs shape their career trajectories. This study is among the first to focus on internationally educated physiotherapists and their experiences with the bridging program as they progress through the integration process into the Canadian healthcare system. Specific aims: This study aims to assess the effectiveness of bridging programs in supporting the professional adaptation of IEPTs in Canada. Also, an important part of research is identifying facilitators that improve the chances of successful integration into a new healthcare system and barriers that may delay it. Methods: Adopting a qualitative case study approach, the research involved in-depth interviews with graduates and an instructor of a bridging program for IEPTs to explore their experiences. For understanding their experience, seven participants, including six graduates who are currently practicing physiotherapists and an instructor of a bridging program in Canada, were interviewed. The interviews were conducted in a semi-structured format via one-on-one Teams videoconferences. Interviews ranged from 45 to 60 minutes in duration. Three members of the research team, the supervising professor, a graduate student, and a volunteer student, independently checked the equivalence of the transcripts and synchronized them with the audio files of the interviews. In addition, the documents of the two currently active bridging programs, the McGill University Equivalency in Physiotherapy Program and the University of British Columbia Physio Refresh, were thoroughly analyzed in comparative terms of their core elements. A rigorous thematic analysis, guided by an evaluation framework (Kirkpatrick’s New World model), was applied to ensure that all facets of “effectiveness” were considered. Codes were generated using the Braun and Clarke methods. Results: In the study, interviewed participants showed a significant positive impact of the bridging programs for adaptation in the Canadian health system. The finding also revealed factors that facilitate successful careers, and notable barriers for internationally educated physiotherapists to achieving positive outcomes on their pathway to becoming registered physiotherapists in Canada. Factors of success included early information support on accreditation processes for physiotherapists, availability of financial support, professional networking, and social support. The common barriers for our participants were financial pressure, bureaucratic uncertainty, and the complex regulation of the licensing process. Useful recommendations from the participants were to streamline the process of accreditation; unification of the process of licensing physiotherapists in Canada for those trained in historically closer health systems; in addition, graduates emphasized the crucial role of the clinical placements, the positive impact of an individual approach for every IEPT's credentials, and the importance of peer support. Discussion: This research highlights the work of bridging programs in successfully integrating internationally educated physiotherapists into Canadian practice. Within their bridging program, study respondents reported that they were introduced to cultural differences and to new professional identities that are intended to help them meet the requirements of provincial physiotherapy association norms. Graduates aimed to obtain accreditation in the provinces as an independent physiotherapist, a goal strongly associated with completing the bridging program. Provincial requirements for registering new physiotherapists in Quebec do not require a national exam after successful completion of an accredited bridging program, whereas other provinces require it. This shows one of the positive aspects of registration in Quebec, as it was continuously underscored by participants in the study. A comparative look shows that the McGill University program has a longer clinical placement, while the UBC program has a shorter overall duration and more flexible modes of delivery, such as a hybrid format or remote delivery. Notable strengths of the bridging programs were that the higher number of seats offered by UBC allows physiotherapists to have more chances of receiving an offer from the Physio Refresh program. In addition, because UBC does not mandate permanent resident status in Canada for their candidates, the Physio Refresh program might be an option for physiotherapists without permanent resident status. The McGill program offered the opportunity to omit the national exam mandate after finishing their Equivalency in Physiotherapy Program and extended clinical placement exposure. The limitations for both programs were still limited capacity of the programs, high tuition charges, and periodic repetition of course materials from students' initial degrees, and for clarity, these courses were prescribed by the regulatory body (Ordre Professionnel de la Physiothérapie du Québec, 2026) and could not be changed by the bridging programs. Conclusion: The bridging programs for internationally educated physiotherapists help their graduates improve their chances of licensing in physiotherapy in Canada and start their careers with confidence. Findings of this study identified several facilitators that have not received attention in past studies. These include peer network support for the learning process, as well as early clinical placement, interprofessional communication, exposure to new work culture, financial support, and an advanced level of professional language. Notably, barriers included complex, non-coordinated regulations governing the physiotherapy specialty and individual factors that prolonged the registration process. The findings of this study will be helpful in the design of streamlined and standardized processes for credential recognition, with a “one window” approach for candidates from regulating bodies in the provinces. For candidates, it will be more effective to understand before applying and moving to Canada, the main requirements for the licensing process, the expected timeline for credentials recognition, and the bridging programs’ curriculum. IEPT students starting the McGill University bridging program joined the mainstream master 's-level physiotherapy cohort and were not segregated into a separate Equivalency in Physiotherapy Program stream, which was a consequential facilitator of their academic and professional development. This integration created organic peer learning opportunities, reduced professional isolation, and fostered a sense of belonging within a community of practice. These relational dimensions of learning align directly with the Reaction level of the New World Kirkpatrick Model (Kirkpatrick & Kirkpatrick, 2022).