Eligibility, Participation, and Matching Outcomes of International Pharmacy Graduates in Accredited Pharmacy Residency Programs in Canada: A Policy Scan and Cross-Sectional Analysis.

Background:International pharmacy graduates (IPGs) are underrepresented in Canadian hospitals. It has been speculated that structural factors, particularly limited access to residency programs, may contribute to IPGs' disproportionate streaming toward community pharmacy practice. Objectives:To review the criteria of accredited hospital pharmacy residency programs in Canada to determine whether IPGs are eligible to apply, to examine the extent of IPGs' participation and success in securing hospital pharmacy residency positions, and to determine the factors that influence success in the matching process. Methods:A policy scan of accredited residency programs that participate in the Canadian Pharmacy Residency Board matching program was conducted in September 2023. In addition, a descriptive cross-sectional study was performed using available application data from the Pharmacy Residency Application and Matching Service in Canada for the 2022/23 matching cycle (January 2023 match). Results:Of the 40 participating residency programs, 7 (17.5%) required graduation from a North American-accredited institution, whereas the others accepted candidates with eligibility for licensure in any Canadian province. Only one program explicitly mentioned and encouraged IPGs to apply. In the matching data, only 19 (6.2%) of 308 applicants were IPGs, of whom 3 (16%) were successfully matched to a program, whereas 131 (45.3%) of 289 domestic graduates were matched. There was a significant association between country of graduation and residency matching, with lower odds of matching for IPGs (adjusted odds ratio 0.230, 95% confidence interval 0.063-0.845). Conclusion:These results show that IPGs are substantially underrepresented in the residency application and matching processes and provides insights into potential systemic barriers that need to be addressed by policy-makers and stakeholders.