A review of remediation programs in pharmacy and other health professions

Perceptions of Remediation Policies and Procedures in Pharmacy Education

OBJECTIVE

This study aimed to (1) explore the perceptions of current remediation processes among pharmacy program administrators and faculty, and (2) identify factors surrounding successful or unsuccessful remediation in a pharmacy program.

METHODS

This qualitative study used the following 3 stakeholder focus groups with distinct perspectives: didactic faculty, experiential faculty, and administrators. A screening survey was used to identify eligible participants, and quota sampling was used to represent various institution types and stakeholder experience. Focus groups were conducted using structured interview questions by an expert interviewer who was not part of the research team. Data were coded using the constant comparison method until consensus was achieved on the identified themes.

RESULTS

Three themes associated with remediation were identified with 12 coded categories. The codes discussed by all 3 stakeholder groups included methods to identify students who need remediation, types of remediation, remediation challenges, consequences of remediation, remediation effectiveness, and necessary improvements to the remediation process. The didactic and experiential faculty groups discussed the management of remediation plans, methods of remediation prevention, and lessons learned from remediation. The timing of remediation was discussed by didactic faculty. The experiential faculty noted the need for preceptor development to provide timely feedback and ensure successful remediation. All 3 groups mentioned having clear policies and procedures for successful remediation.

CONCLUSION

Overall, faculty and administrators had similar perceptions regarding remediation practices. The differences in concerns about remediation were most notable between the experiential and didactic faculty. While all 3 groups believed that remediation may be useful and necessary, challenges remain and monitoring is needed to determine the most effective practices, particularly in experiential education.

Retooling the Remediation Process: An Overview of One School's Process Overhaul

OBJECTIVE

This article describes the process of review and modification of a Doctor of Pharmacy didactic course remediation process. A highlight of the new process includes early intervention with a Learning Specialist, creating the opportunity for students to address learning issues earlier in the courses.

METHODS

Review of past remediation processes, student success, and pertinent literature related to remediation processes to allow for a new remediation process that supports students' learning and success.

RESULTS

Creation of a new 2-phase process, including an early intervention and remediation process. The process includes a Learning Specialist position to focus on learning and barriers to academics. Remediation opportunities focus on proficiency in specific areas for each course.

CONCLUSION

The new remediation policy provides greater support to students through the Learning Specialist. The new policy helps students connect with resources earlier in the program and provides multiple opportunities for assisting students during the semester. Over the past 4 years, the Learning Specialist has met with an average of 73 individual students per semester, while only an average of 25 students in the didactic portion of the curriculum (year 1-3) require remediation each semester.

Evaluation of an individual examination remediation policy in a professional pharmacy course

INTRODUCTION

Maintaining institutional remediation policies is required for pharmacy education accreditation, but specific policies and students' perceptions of remediation are not well described in the literature. The purpose of this research was to determine whether the individual examination remediation policy utilized in a biomedical literature evaluation course was a viable approach to ensuring positive student experiences and success.

METHODS

This study utilized a pre-/post-quantitative survey design. An 11-item pre-remediation questionnaire was offered to all students enrolled in the course in 2022. A matched post-survey was administered to students eligible to remediate individual examinations. Survey items were assessed using a five-point Likert rating. Remediation examination grades were analyzed in aggregate. Descriptive statistics were utilized as appropriate.

RESULTS

One hundred of the 108 (92.5%) enrolled students completed the pre-remediation survey. Students strongly agreed they would prefer to remediate individual examinations instead of taking one cumulative course remediation examination (median 5) and that remediating would improve their understanding of course material (median 5). Nineteen (44%) of 43 students eligible for individual examination remediation chose to remediate, and 16 (37%) responded to the post-remediation survey. Among those eligible, the most common reason for remediating was desire to receive a better score. Significantly more students improved their examination scores through remediation.

CONCLUSIONS

Students in the course preferred to remediate individual examinations, but only 44% of students eligible to remediate chose to do so. Future studies with larger sample sizes and course outcome data are warranted to further explore examination remediation in professional pharmacy courses.

Benchmark Report on Utilization of Faculty Workload Models in Colleges and Schools of Pharmacy

This commentary offers a call to action to develop equity-minded, evidence-based faculty workload policies and practices within colleges and schools of pharmacy. The University of Maryland School of Pharmacy sponsored an investigation to characterize and compare peer schools' models for measuring and using faculty workload data. An external consulting group selected 28 colleges and schools of pharmacy based on characteristics similar to the University of Maryland School of Pharmacy and collected information, feedback, and data on how these programs assessed faculty workload. Exploratory emails and phone interviews were used to collect these data. Nine of the 28 programs participated in additional follow-up discussions. These interviews identified common themes, although there was wide variability in design and implementation of workload models, even among comparable institutions. These findings align with the national Faculty Workload and Rewards Project that explored how faculty workload models can perpetuate inequities and undermine productivity, satisfaction, and retention.

Frequency of Course Remediation and the Effect on North American Pharmacist Licensure Examination Pass Rates

Objective. Remediation is a tool that allows students to correct an academic deficiency after earning an unsatisfactory grade. There is a lack of data on remediation processes and their impact on future academic performance. This study aimed to evaluate the impact of remediation frequency on North American Pharmacist Licensure Examination (NAPLEX) performance.Methods. The primary analysis was the relationship between the NAPLEX first-time pass rate and the frequency of course remediations (no remediations, one remediation, and two or more remediations). Additional analyses included the correlation between the NAPLEX scaled score and the number of course remediations and characteristics of the course remediated.Results. A total of 116 students with NAPLEX data were included for analysis. Compared to students who never remediated, NAPLEX first-time pass rates were similar among those who remediated only one course; however, students who remediated two or more courses had significantly lower NAPLEX pass rates. Remediation in courses mapped to Pharmacy Curriculum Outcomes Assessment (PCOA) area 4.0 (clinical sciences), and courses with mixed PCOA content areas were negatively correlated with NAPLEX scaled scores. A significant negative correlation existed between remediation in students' second or third years in pharmacy school and the NAPLEX scaled score, but this correlation was not significant for students in their first year.Conclusion. Multiple course remediations are negatively correlated with NAPLEX scaled scores and a reduced first-time NAPLEX pass rate, but a single course remediation has no effect. Institutions should aim to evaluate their current remediation practices and assess whether additional support should be provided to students with multiple course remediations.

The life raft to keep students afloat: Early detection, supplemental instruction, tutoring, and self-directed remediation

PROBLEM DESCRIPTION

To decrease delayed graduation and student dismissal, we developed a systematic process to identify and intervene with students with academic challenge across the first three years of the curriculum.

QUALITY IMPROVEMENT METHODS

Four strategies were implemented to support student academic success: early identification of academic challenge, supplemental instruction, tutoring, and remediation. Outcomes were tracked through the number of students requiring remediation, academic performance during remediation, and changes in delayed graduation and academic dismissal.

RESULTS OF CQI INQUIRY

The number of students requiring remediation has decreased each year since implementation in 2017 to 2020 (54, 36, 30, and 21, respectively). The rate of successful remediation has ranged from 72% to 87%. Strategies to support student success have resulted in decreased delayed graduation and academic dismissal.

INTERPRETATION AND DISCUSSION

Commitment to academic success was a culmination of resources to support students, including the investment in an academic performance specialist and paid supplemental instructors. A focus on student success has led to awareness of additional strategies that may be employed to enhance the student support program. These include creating a culture of no shame for receiving academic support and mandating some activities for students who do not maintain a minimum threshold.

CONCLUSIONS

A holistic approach to academically support students that included preventive and interventional strategies was successful in decreasing delayed graduation and academic dismissal.

Considerations for remediation policy and procedures in pharmacy education

INTRODUCTION

Despite the heterogeneous nature of remediation definitions, processes, and impact on learning, it is commonly understood as a process for identifying student deficiencies in knowledge, skills, and attitudes that need to be corrected prior to student progression in the program.

COMMENTARY

Current issues related to remediation in pharmacy education include inconsistencies in practices and types within and among institutions, a lack of correlation to student academic success, effects on attrition both positive (student staying on-time for graduation) and negative (students sitting back one year), increase in faculty workload, and negativity or stigma associated with the student.

IMPLICATIONS

Key considerations in developing and implementing remediation policies and procedures include being student-focused, providing a positive frame for remediation, implementing a clear process, and early identification of students who need help.

Interactive Narrative Simulation as a Method for Preceptor Development

(1) Background: This proof-of-concept study assessed an interactive web-based tool simulating three challenging non-academic learning situations—student professionalism, cross-cultural interactions, and student well-being—as a means of preceptor development. (2) Methods: Three scripts focused on professionalism, cross-cultural interactions, and student well-being were developed and implemented using a commercial narrative tool with branching dialog. Delivered online, this tool presented each challenge to participants. Participants had up to four response options at each turn of the conversation; the choice of response influenced the subsequent conversation, including coaching provided at the resolution of the situation. Participants were invited to complete pre-activity, immediate post-activity, and one-month follow-up questionnaires to assess satisfaction, self-efficacy, engagement, and knowledge change with the tool. Knowledge was assessed through situational judgment tests (SJTs). (3) Results: Thirty-two pharmacist preceptors participated. The frequency of participants reflecting on challenging learning situations increased significantly one-month post-simulation. Participants affirmatively responded that the tool was time-efficient, represented similar challenges they encountered in precepting, was easily navigable, and resulted in learning. Self-efficacy with skills in managing challenging learning situations increased significantly immediately post-simulation and at a one-month follow-up. Knowledge as measured through SJTs was not significantly changed. (4) Conclusions: Preceptors found an interactive narrative simulation a relevant, time-efficient approach for preceptor development for challenging non-academic learning situations. Post-simulation, preceptors more frequently reflected on challenging learning situations, implying behavior change. Self-efficacy and self-report of knowledge increased. Future research is needed regarding knowledge assessments.

Pharmacy student reflections and perceptions of competency and predictors of success in remediation

INTRODUCTION

Pharmacy programs employ a variety of remediation methods intended to bring underperforming students to a level of competency. Our objective was to evaluate pharmacy students' perceptions of eligibility criteria and academic outcomes of remediation and potential predictors for lack of success in the original and remediated course.

METHODS

Palm Beach Atlantic University School of Pharmacy revised its remediation policy in fall 2017, shifting from a course-centric to student-centric policy. Pharmacy students (N = 265) were surveyed in spring 2019 regarding eligibility criteria and academic outcomes of remediation. Enrolled students who remediated under the revised policy were surveyed on the lack of success in the original course and the remediation process.

RESULTS

Students viewed remediation as an opportunity to prevent delayed graduation. They agreed with the revised, student-centric eligibility criteria and with the new approach allowing all courses to be remediated. First-year students provided lower scores, whereas students who never failed a course gave higher scores. Students agreed that remediation produces proficient students who are as competent as those who passed the original course. The main reason for failing the original course was lack of study time. Students who failed remediation tended to spend more time on external activities and used less remediation resources.

CONCLUSIONS

A student-centric approach to remediation with active involvement from students and faculty support was successful in producing students who are viewed just as proficient and competent as students who passed the original course. Predictors for success were study time and the use of remediation resources.

Improving the Remediation Process for Skills-based Laboratory Courses in the Doctor of Pharmacy Curriculum

When students fail to meet minimum competence standards on summative pharmacy skills-based assessments, remediation can be used to ensure student readiness for progression. Skills-based remediation is challenging as a high volume of resources is required to develop an action plan that addresses the heterogeneity in student needs and to create and execute another assessment equivalent to the initial assessment. Although many Doctor of Pharmacy (PharmD) programs face these same challenges, there is no consensus on how to best address them. Recently, faculty from six PharmD programs convened to share ideas and approaches to overcoming these challenges. This commentary aims to define remediation as it pertains to summative skills-based assessments, share our consensus views regarding remediation best practices, and highlight areas where there is more work to be done. Our intent is to advance the ongoing conversation and empower institutions to develop their own effective and impactful skills-based remediation policies, procedures, and activities.

Technology readiness of medical students and the association of technology readiness with specialty interest

BACKGROUND

Technology readiness (TR) is a construct which characterizes an individual's propensity to utilize new technology. Despite increased technology use in healthcare, limited data exists on medical student TR and the relation of TR with specialty interest. This study assesses the TR of 2nd year medical students and its association with specialty interest.

METHODS

Respondents completed a survey assessing their most preferred specialty, specialty interests, and technology readiness using a 5-point Likert scale. Using Chi-square analysis, we examined the relation between demographics, TR, and specialty interest.

RESULTS

This study obtained a 45.7% (n = 53/116) response rate demonstrating that 79.2% (n = 42/53) of students were "technology ready." Male students were more likely to be technology ready (95.2%, n = 20/21, vs 68.8%, n = 22/32, p = 0.02) when compared to female students. Technology ready students were associated with being more interested in "Technology-Focused" specialties compared to students who were not technology ready (88.5%, n = 23/26 vs 70.4%, n = 19/27, p = 0.104).

CONCLUSIONS

As a cohort, most medical students were technology ready. It is inconclusive if technology ready students are more likely to be interested in technology-focused specialties due to the limited sample size of this study, although with an increased sample size, an improved understanding on technology readiness and its potential impact on student specialty interest may be obtained. Furthermore, knowledge of TR may aid in developing targeted technology-based education programs and in improving remedial approaches for students who are less comfortable with new technology.

Intervention and remediation: A descriptive study of practices in pharmacy education

INTRODUCTION

This descriptive survey study was designed to collect specific data about intervention and remediation approaches used by schools and colleges of pharmacy (S/COPs) to meet the requirements of the Accreditation Council for Pharmacy Education Standard 17.

METHODS

An electronic survey was developed and sent to all members of the American Association of Colleges of Pharmacy Curriculum and Student Services Personnel Special Interest Groups. The survey gathered details about institutional criteria and practices used in identification of students at risk of failure, steps of early intervention, and approaches to academic remediation. Descriptive data are presented.

RESULTS

About 70% of accredited S/COPs responded with a complete survey. There was no statistically significant difference between public or private institutional practices. All respondents reported remediation approaches, but only 85% had structured intervention practices. There was marked variability in reports of specific details for both intervention and remediation.

CONCLUSIONS

There is great diversity in approaches to both intervention and remediation. This study provides baseline data on which to build future research that might determine best practices to optimize student outcomes. A theoretical framework is provided.

Supporting students with academic difficulties

INTRODUCTION

Up 15% of health professions students experience academic difficulties. We describe an early tracking system that effectively identifies and supports students with performance deficiencies. The objectives of this study were to discuss changes made in an academic success system at our new college of pharmacy, describe effectiveness of the updated program after one-year of use, and present changes that are being discussed based on the faculty and student feedback.

METHODS

We conducted in-person faculty interviews using open-ended questions to evaluate the effectiveness of our original program for supporting students with academic difficulties called the Early Tracking System (ETS). We then developed a new program titled the Individualized Plan for Academic Success System (IPASS). We conducted more faculty interviews and a student survey after the implementation of IPASS to evaluate its effectiveness.

RESULTS

In the 2018-2019 academic year at our institution, IPASS was activated 291 times, of which there were 27 course failures. The results of our study indicated a pass rate of 90.72% post-IPASS for all pharmacy students.

CONCLUSIONS

The goal of this study was to revise and implement an early tracking system that all faculty members, students, and administrators can utilize efficiently and effectively. This study demonstrated that students with academic difficulties have the potential for progression if their deficiencies are detected early. We described a unique system by which we addressed the needs of the at-risk students. The interview of faculty and survey of students indicated satisfaction with IPASS.

Remediation and reassessment methods in pharmacy education: A systematic review

BACKGROUND

Colleges of pharmacy are currently required to implement a remediation program within their curricula, but no specifications are provided on the ideal methodology. While the need for successful remediation strategies continues to grow, literature describing positive or negative outcomes of different approaches is significantly lacking. The objective of this literature review was to describe and evaluate remediation methodologies in pharmacy education.

METHODS

This literature review was completed following PRISMA criteria. A search of the PubMed, Cochrane Library, Cumulative Index of Nursing and Allied Health, Academic Search Complete, PsycInfo, Scopus, and ProQuest Central databases was conducted in July 2019. Studies were included if they involved pharmacy student education and described either remediation or reassessment.

RESULTS

The evaluated studies discussed a range of course types being remediated, a large variety of remediation strategies and timeframes, and differing overall outcomes. No studies provided comparison of remediation techniques or provided details on the implementation of their chosen approaches. A consistent finding within the evaluated studies was the inclusion of prevention strategies to attempt to avoid the need for remediation preemptively. Overall outcomes for each remedial program were inconsistent and no clear patterns were evident other than an improvement in student performance following remediation.

IMPLICATIONS

Remediation strategies included course repetition, summer restudy, reassessment, and individualized plans. Outcomes varied significantly between studies, making methodology comparisons difficult. Future studies that include more detail and consistency in the reported outcomes would be beneficial to students and help clarify remediation for colleges of pharmacy.

Confirmative Evaluation: New CIPP Evaluation Model

Struggling trainees often require a substantial investment of time, effort, and resources from medical educators. An emergent challenge involves developing effective ways to accurately identify struggling students and better understand the primary causal factors underlying their poor performance. Identifying the potential reasons for poor performance in medical school is a key first step in developing suitable remediation plans. The SOM Modified Program is a remediation program that aims to ensure academic success for medical students. The purpose of this study is to determine the impact of modifying the CIPP evaluation model by adding a confirmative evaluation step to the model. This will be carried out by conducting a program evaluation of Wayne State University’s School of Medicine Modified Program to determine its effectiveness for student success. The key research questions for this study are 1) How effective is the Modified Program for student’s success in the SOM? 2) Do students benefit from a modified program in medical school? 3) Will the CIPP program evaluation model become more effective by adding confirmative evaluation component?

Predictors of Student Failure or Poor Performance on Advanced Pharmacy Practice Experiences

Objective. To determine factors predictive of student failure or poor performance on advanced pharmacy practice experiences (APPEs) at a single pharmacy program. Methods. This retrospective cohort evaluated students entering the Doctor of Pharmacy (PharmD) program from 2012-2014 at St. Louis College of Pharmacy. Students who received a grade of F for one or more APPEs (failure group) were compared to all other students (non-failure group). A secondary evaluation compared students with a C or F on one or more APPEs (poor performers) to all other students (non-poor performers). Data were collected on didactic and experiential performance, identifiable professionalism issues from introductory pharmacy practice experiences (IPPEs), and academic honor code violations. Univariable and multivariable logistic regressions were performed to determine factors associated with APPE failure and poor performance. Results. A total of 669 students were analyzed. Twenty-eight students (4.2%) failed one or more APPEs and 81 students (12.1%) were identified as poor performers (grade of C or F). For the primary outcome, professional grade point average (GPA) of less than 2.7, practicum failure, IPPE professionalism issue(s), and pharmacotherapy course failure were identified for inclusion in the multivariable analysis. The IPPE professionalism issue(s) (HR 4.8 [95% CI 1.9-12.4]) and pharmacotherapy course failure (HR 4.2 [95% CI, 1.6-11.1]) were associated with APPE failure on multivariable regression. On the secondary analysis, the same variables were identified for multivariable regression, with professional GPA of less than 2.7 (HR 2.7 [95% CI 1.5-5]), IPPE professionalism issue(s) (HR 3.9 [95% CI 2.2-6.9]), and pharmacotherapy course failure (HR 2.0 [95% CI 1.1-3.7]) associated with poor performance. Conclusion. Poor academic performance and/or identified unprofessional behavior while completing IPPEs are associated with APPE failure and poor performance. Interventions should be aimed at identifying at-risk students and addressing risk factors prior to APPEs.

Impact of Intersession Course Remediation on NAPLEX/PCOA Scores in an Accelerated Doctor of Pharmacy Program

Objective. To compare Pharmacy Curriculum Outcomes Assessment (PCOA) scaled scores and North American Pharmacist Licensure Examination (NAPLEX) pass rates in students who completed a two-week intersession remediation or repeated a course with the scaled scores and pass rates of students who did not require any form of didactic remediation and did not have to repeat a course. Methods. Data examined for this study included NAPLEX/PCOA scores, NAPLEX pass/fail status, and remediation history for students at one college of pharmacy. Students from the graduating classes of 2016, 2017, and 2018 were organized into four groups: non-remediation, one course remediation and no repeats, more than one course remediation and no repeats, and one or more course repeats. Differences were analyzed using linear regression, logistic regression, and Pearson correlations. Results. The PCOA scores for students in the remediation groups were significantly lower than scores for students in the non-remediation groups, with a reduction of 37.8 to 50.9 points from the expected non-remediators' score. The NAPLEX scores for students who remediated more than one course or repeated one or more courses were 16-20 points lower compared to students who did not remediate. The likelihood of a student failing the NAPLEX was also not significantly lower for students who remediated one course but was significantly lower for other remediation groups. Conclusion. Although single course remediation in this curricular model appears to have minimal impact on NAPLEX outcomes and may be an acceptable intervention for many students, additional support and interventions may be warranted for students who qualify for remediation in multiple courses and/or for repeating a course.

Modification of the self-regulated strategy inventory-self report for blended and team-based learning

INTRODUCTION

One of the primary missions of pharmacy education is to produce graduates with the foundations to develop into expert practitioners through continuous learning and reflection upon traditional and clinical experiences. This reflection process and the use of effective strategies to meet specific learning goals can be considered a form of self-regulated learning (SRL). The following study validates an inventory to assess SRL strategies in blended and team-based learning (TBL) environments.

METHODS

A SRL strategy inventory was developed based upon the Self-Regulated Strategies Inventory-Self-Report (SRSI-SR) and new items designed for blended and TBL environments. Sixteen new items focused on leveraging the team to learn content, the use and misuse of video lectures and slides, and interaction with social media and the learning management system. Two hundred and thirty doctor of pharmacy students in the third professional year participated in the study. Twenty-eight items from the SRSI-SR and 16 new items were examined through a principal components analysis (PCA).

RESULTS

The PCA indicated three distinct components; managing learning environment, maladaptive learning strategies, and seeking and learning information. The total inventory accounted for 46.36% of the score. Maladaptive learning strategies scores were moderately predictive of poor academic achievement in didactic coursework.

CONCLUSIONS

The following study demonstrates the importance of reexamination and adaptation of educational inventories such as the SRSI-SR. This study provides specific insight into what maladaptive strategies may be limiting underperforming students from achieving greater success and mastery in the didactic curriculum.

Student Personality Style and First-Year Academic Performance in a Doctor of Pharmacy Program

Objective. To evaluate whether the personality styles of Doctor of Pharmacy (PharmD) students as determined by the DiSC assessment are associated with students' cumulative grade point average (GPA) or with academic penalties imposed in the first year of a PharmD program. Methods. All incoming PharmD students that provided informed consent and completed the DiSC personality assessment were included in the study. Participants provided demographic data and forwarded their electronic DiSC assessment results to study investigators upon completion. Relevant academic data were collected at the end of each semester. Results. The overall response rate for the classes of 2019-2022 was 95.6%. No significant associations were found when comparing personality styles as defined by the DiSC assessment and cumulative GPA at the end of the first year. Additionally, no associations were noted when comparing students' personality style and semester GPA or academic penalties received. Conclusion. Understanding factors that contribute to students' academic success can aid in early identification of students who are likely to succeed and of students who may benefit from early academic intervention. While no significant associations were found in the first-year of the curriculum, continued evaluation will be conducted to determine the impact of personality style on students' overall academic performance beyond the first year of the PharmD curriculum.

Factors Associated with Student Pharmacists' Academic Progression and Performance on the National Licensure Examination

Objective. To examine predictors of Doctor of Pharmacy (PharmD) students' on-time graduation, dismissal from pharmacy school, and scores on their first attempt at taking the North American Pharmacist Licensure Examination (NAPLEX). Methods. A retrospective review of student records for the graduating classes of 2015-2018 at a college of pharmacy was performed. Data on the following were collected: student demographics/characteristics (age, gender, race/ethnicity, financial need), having an undergraduate degree, undergraduate science grade point average (GPA), Pharmacy College Admission Test composite score percentile, pharmacy school GPAs for the didactic portion of the curriculum, Pre-NAPLEX score, on-time graduation from pharmacy school, dismissal from pharmacy school, and outcome (pass/fail) of first-attempt at taking the NAPLEX. Binary logistic regression analysis was conducted. Results. Of the 657 students whose records were included in the study, the majority were female (60%) and non-Hispanic white (70%). Higher first-year GPA was associated with increased likelihood of on-time graduation, while increased age and having an undergraduate degree were associated with a decreased likelihood of on-time graduation. A higher first-year GPA was associated with decreased likelihood of being dismissed from pharmacy school. Appearing before the Academic Standing and Promotion Review Committee for unsatisfactory academic performance was associated with decreased likelihood of passing the NAPLEX. Conclusion. First-year pharmacy school GPA is a critical predictor for student pharmacists in terms of on-time graduation and dismissal, and may have consequences for later NAPLEX outcome. Pharmacy schools should closely monitor students' performance during the first year and provide support to students experiencing academic difficulties.

Intersession Remediation to Minimize Attrition in a Three-Year Pharmacy Program

Objective. To describe an intersession remediation process in an accelerated three-year Doctor of Pharmacy (PharmD) program and to determine if the remediation process reduced attrition rates, including program withdrawals, progression to advanced pharmacy practice experiences (APPEs), and on-time graduation rates. Methods. Attrition was defined as dismissal, withdrawal, leave of absence, and/or change in graduation date. Progression data from students who matriculated between 2008 to 2016, with data available through spring 2017, were analyzed for number of course failures and successful intersession remediation. Other factors such as pharmacy year (first or second year), course subject, and course repeats were evaluated to characterize successful remediation attempts and identify elements that foster student success. Results. Of the 812 matriculated students across the time period analyzed, 18% (n=146) failed at least one didactic course (defined as course average <69.5%). Overall, 74.7% (n=109) of the students who failed a course remediated, with 75.2% (n=82) of those able to remediate being successful, remaining on-time for graduation. If students who remediated were instead required to repeat coursework, the college attrition rate would have averaged over 10 percentage points higher for the time period analyzed than the actual rate of 13.4%. Conclusion. Our study demonstrated that the majority of students who qualified for remediation were successful and graduated on time. Further studies in this area are needed to fully elucidate the effect of remediation processes on learning and retention of knowledge and skills.

Development and assessment of an academic performance enrichment program for low-performing, first-year pharmacy students

Pharmacy school applications have steadily declined over the past several years. Thus pharmacy schools are not only searching for effective means to increase enrollment of qualified candidates, but are also focusing on the development of programs to improve academic performance and retention of enrolled students. To address the needs of struggling first-year pharmacy students enrolled in an Integrated Biological Sciences (BSI) course, an academic performance enrichment program (APEP) was developed. The program was designed to improve academic success by engaging low-performing students with the aims of improving their time management skills, study skills, metacognition, and understanding of BSI course material. The APEP consisted of structured tutoring sessions twice per week, which were required for all students with a course grade ≤73.5% at any point during the semester. To assess program effectiveness, performance improvement on BSI exams by the APEP students were compared with that of non-APEP students in the same class and to those in the previous 3 yr. Student perceptions of the program were also evaluated via an online survey. The APEP was deemed effective in that a greater percentage of students were able to improve their exam scores and to a greater extent by attending the APEP sessions compared with non-APEP students in the same class and with low-performing students in previous years when the APEP did not exist. Furthermore, APEP students believed the program was effective in meeting its aims. In conclusion, the APEP was effective in improving academic performance of low-performing students in BSI.

Effect of preceptor-initiated referral system on advanced pharmacy practice experience (APPE) students' rotation progress and graduation rate

INTRODUCTION

The objective of this study was to determine whether the referral and monitoring system developed at Butler University College of Pharmacy and Health Sciences (BUCOPHS) for advanced pharmacy practice experience (APPE) students is successful in improving on-time and overall graduation rates and decreasing rotation failures.

METHODS

In May 2014, a formalized process for referral and monitoring of APPE students was established. This allows preceptors to recommend (via the electronic final evaluation form) additional monitoring or intervention in the areas of professionalism, time management, drug information, communication, and therapeutic/drug knowledge. The experiential education director subsequently meets with referred students and develops a customized longitudinal plan to help each student improve in the identified areas. Data collected for students who were referred included the rotation block, rotation type, preceptor type, and the specific areas recommended for monitoring and referral. In addition, each student's quarterly progress, specific assessments outlined in each student's customized longitudinal plan, number of failed rotations, on-time graduation, and overall graduation status was recorded. The university's institutional review board approved the study.

RESULTS

Between May 2014 and April 2017, a total of 36 students were referred to the experiential education office for monitoring and/or intervention. Of these, 35/36 (97.2%) graduated on time. There were eight students who failed one APPE; no students received more than one failure.

CONCLUSIONS

Development of a referral and monitoring system for preceptors aids in retention of professional pharmacy students and increases on-time and overall graduation rates.

Remediation Models Used in a Pharmacy Calculations Course

Remediation is a required component of pharmacy programs. In a pharmacy calculations course, two student-centered models of remediation have been utilized. These models were a shift from an intensive, hands-on infrastructure of faculty and student engagement to a more student self-directed process. The models utilized development of an individualized plan for each student, clearly outlined expectations, faculty availability for consultation, as well as flexibility in remote completion of the assigned activities. Both models resulted in student success.

Evaluation of peer-led study groups in a PharmD program

INTRODUCTION

Academic support in the form of formal, peer-led study groups was initiated at a four-year college of pharmacy utilizing paid group facilitators and a student program coordinator under the direction of the Associate Dean for Student Affairs. This study's purpose was to assess the first year of this program from the viewpoints of the student participants, study group facilitators, and faculty.

METHODS

Student, study group facilitator, and faculty perceptions of the study group initiative were collected following the first year of operation via cross-sectional surveys and qualitative content analysis. Surveys addressed the perceived value of study groups and their impact on study habits, supportive relationships, and professional growth. A five-point Likert scale was used to note participants' level of agreement with each survey item, while open-ended questions gathered subjective feedback. The mean, standard deviation, and frequency were calculated for each survey item across the three participant groups and qualitative themes from free-responses were identified.

RESULTS

Student survey responses overwhelmingly supported the value and continuation of study groups (93% to 100% agreed or strongly agreed), with both participants and facilitators expressing enthusiasm for the program. Facilitators felt adequately trained (85.7%) and that their roles positively influenced their professional development (85.7% to 100%). Faculty respondents agreed that the program was valuable and should be continued.

CONCLUSIONS

Overall, students and facilitators perceived study groups to be valuable in supporting the academic success of pharmacy students.

Academic success plans in advanced pharmacy practice experiences to promote self-awareness and improve performance

INTRODUCTION

Pharmacy schools should encourage self-awareness, provide exposure to the continuous professional development cycle, and intervene early when students exhibit performance deficiencies. Academic success plans (ASPs) have been shown in other disciplines to be successful intervention tools which encourage student reflection and self-awareness. This study evaluates the impact of ASPs used during the advanced pharmacy practice experience (APPE) curriculum at two schools.

METHODS

ASPs were assigned to students who had either a "needs development" or lower documented for the same learning outcome during more than one APPE, for poor overall performance during an APPE, or for documented professionalism issues. Average scores were calculated by assigning point values to each learning outcome assessment score (exceeds expectations = 1; competent = 0; needs development, needs significant development, remediation required = -1).

RESULTS

During AY2014-2015 and AY2015-2016, 104 ASPs were assigned to 75 students (13.5% of students). The majority (89.6%) were assigned due to repeated deficiencies in the same learning outcome(s), with the most frequent being "Develop, Implement, and Monitor Drug Therapy Plans." After completion of an ASP, average scores significantly improved (p < 0.05) in 9 out of 12 learning outcomes among all students who completed an ASP. Thirteen students completed 15 ASPs for professionalism reasons, most commonly punctuality.

CONCLUSIONS

Prior to 2015, Experiential Education Office interventions were primarily grades-based, not necessarily based on achievement of specific learning outcomes. ASPs were successfully used to allow students to practice self-awareness skills, to engage in the CPD process, and to improve APPE performance.

Effects of targeted remediation in anatomy for first year medical students

The aim of this study was to assess the effectiveness of a questionnaire to guide targeted remediation among undergraduate medical students in anatomy. Seventy-five students from a medical college in South India who failed in the first internal theory examination were administered a validated 35-item questionnaire. The total and domain specific questionnaire scores were calculated. Specific weekly interventions for each student based on the questionnaire scores were conducted by appointed academic mentors for three months prior to the second internal examination. The dependent variable was performance in the second internal examination. The students were re-administered the questionnaire after the second internal examination. The independent variables were the marks obtained in the first internal examination, domain specific and total questionnaire scores, sex, and regularity of the student in attending the remedial sessions. Inferential statistical tests used were the chi-square test, independent sample t test, paired t test, multiple regression and binomial logistic regression. Of the 75 students who underwent remediation, 54 (72%) passed in the second internal examination. The scores in the second internal examination among these students was found to be significantly higher as compared to the first internal examination. The total, subject related and study skills questionnaire score were significantly lower after remediation. Students who were irregular had a significantly lower pass rate. The multivariate analysis showed that only the first internal marks added significantly to the prediction about second internal performance. This study provides evidence to show that struggling students perceive a benefit from targeted remediation.

Multifaceted remediation program: experience of a residency program to rescue residents who failed the American Board of Anesthesiology basic examination

PROBLEM

Passing the American Board of Anesthesiology (ABA) basic examination is required to progress through anesthesiology training in USA. Failing the test may be related to medical knowledge gaps, presence of negative psychosocial factors, and/or individual approaches to learning. This article describes the experience of development and implementation of a multifaceted remediation program (MRP) in residents who failed the ABA basic test.

INTERVENTION

This is a retrospective analysis of four cases of residents who failed the ABA basic test between 2016 and 2017. The MRP is described. Pedagogical diagnosis, objectives, teaching strategies and assessment, and their constructive alignment are presented. Information regarding test performance is also presented.

CONTEXT

This study involves accredited anesthesiology residency program in USA. Outcomes: Four subjects (11% of program residents) failed the ABA basic test. Superficial approach to learning was observed in 100% of cases. The total possible number of participants was 4. The actual number of participants was 4, and the response rate was 100%. Four residents fell under 10th percentile on the first attempt, and 100% passed the test on the second attempt. There was 38% improvement in the number of failed keywords between the two attempts.

LESSONS LEARNED

Implementation of the MRP developed at our institution is successful to remediate anesthesiology residents who fail the ABA basic examination. We learned that the deep analysis of learning approaches, psychosocial factors, and medical knowledge gaps can be used to develop a remediation program based on the constructive alignment between objectives, curriculum, and assessment.

Successful Remediation of an Advanced Pharmacy Practice Experience for an At-risk Student

Objective. To describe a successful remediation for an Acute Care Medicine advanced pharmacy practice experience (APPE) in a student with multiple learning deficits. Methods. A literature review of pharmacy and medical experiential remediation was conducted to identify best practices to implement prior to designing the remediation for our student case. Based on this search and experience as preceptors, a three-phase remediation was designed: one week for assessment, two weeks for development of learning skills and strategies and six weeks for an on-campus APPE. Success of the remediation was determined by student performance, as defined by the APPE preceptor, in all relevant 2013 Center for the Advancement of Pharmacy Education (CAPE) educational outcomes. Results. Baseline assessment indicated that the student was below minimal competency in six of 13 relevant 2013 CAPE educational outcomes. Upon completion of the three-part remediation, the student repeated the Acute Care Medicine APPE, achieving better than minimal competency in all 13 outcomes. The student demonstrated significant improvement in nine of 13 CAPE educational outcomes. Conclusion. This student case provides a novel and successful blueprint for remediation of APPE. However, more evidence-based literature is needed to guide educators in experiential remediation.

Effect of an Individualized Post-Examination Instructor Remediation on Pharmacy Student Performance in a Biochemistry Course

Objective. To assess the effectiveness of a post-examination, one-on-one instructor remediation process on student performance in a pharmacy biochemistry course by measuring the degree of score improvement on a subsequent examination. Methods. Students who scored below 70% on any examination were encouraged to meet with the course coordinator. A typical remediation session lasts about 30 minutes, and covers academic preparation, study habits, concept understanding, application, critical thinking, time management, and stress control. Scores in two consecutive examinations were compared between students who underwent remediation and those who did not. All scores were adjusted for level of difficulty. Results. At-risk students with relatively lower scores are more likely to seek remediation. After receiving a score below 70%, students perform better on the next examination regardless of remediation. However, the remediation process results in a statistically significant 43% increase in the degree of improvement in student performance on the next examination. Conclusion. A post-examination, one-on-one remediation is effective in enhancing student performance in the biochemistry course. As this course is one of the two with the highest failure rates in the PharmD program, current intervention might improve student retention.

Making the Transition from Student to Resident: A Method to Individualize a PGY1 Program

A Postgraduate Year One (PGY1) resident's concerns, limitations, and strengths may be self-identified early in the residency year but are reliant on self-awareness and insight. Program directors commonly find difficulty in identifying a resident's specific knowledge deficits at the beginning of the program. A standardized resident examination can identify limitations early in training and these results can be incorporated into a tailored resident development plan. A total of sixty-two PGY1 residents completed the examination pre- and post-training over a five-year timespan. Scores increased in most core disciplines in each of the five years, indicating an overall improvement in resident knowledge throughout their PGY1 year. The approach of utilizing the scores for the resident's individualized plan allows for customization to ensure that the resident addresses knowledge gaps where necessary.

Relationship of Prepharmacy Repeat Course History to Students' Early Academic Difficulty in a Pharmacy Curriculum

OBJECTIVE

To examine the relationship between students' prepharmacy repeat course history and their academic difficulties early in a professional pharmacy program in conjunction with other prerequisite success variables known to predict academic difficulty.

METHODS

For students admitted to a pharmacy program in 2010 and 2011 (n=160), admission variables [eg, prepharmacy coursework, grade point average (GPA)] and pharmacy program academic difficulty data (ie, academic difficulty defined as a pharmacy GPA in the bottom quartile of the class after 3 semesters of pharmacy course work) were extracted. Regression analysis was employed to examine the relationship between admission variables and academic difficulty.

RESULTS

Twenty-six percent of the students (n=42) repeated a course, and 50% of these students (n=21) repeated more than one course. All of the admissions variables studied were found to individually increase the odds of a student having academic difficulty early in the pharmacy program. Specifically, repeat of a prepharmacy course increased the odds of academic difficulty threefold.

CONCLUSION

Repeating prepharmacy coursework appears to be a strong indicator of future academic difficulties early in a professional pharmacy program.

Use of Cumulative Assessments in U.S. Schools and Colleges of Pharmacy

The Accreditation Council of Pharmacy Education (ACPE) has taken a strong stance on assessment in pharmacy education. One available assessment tool is cumulative assessments, which may be administered at various points in the curriculum. This article presents the results of a survey of U.S. schools of pharmacy regarding the use of cumulative assessments within their curriculum. A 20-question survey tool was emailed to 125 schools of pharmacy. A total of 105 out of 125 schools participated (response rate 84%). Of these, 52 schools currently have a cumulative assessment program; 18 have one cumulative exam prior to advanced pharmacy practice experiences (APPEs); 19 have a cumulative exam every didactic year; and seven have accumulative exams every semester, except during APPEs (n = 44). Increased faculty workload emerged as the top challenge faced by schools that have implemented a cumulative assessment program. Eighteen schools indicated that no outcomes are measured to determine the utility of the cumulative assessment. From these results, it appears that almost half of participating U.S. schools have implemented a cumulative assessment plan. However, it is apparent that more research needs to be done to determine which outcomes are expected to improve with the implementation of such an assessment plan.

Pharmacogenetics of osteoporosis: towards novel theranostics for personalized medicine?

Osteoporosis is a complex multifactorial bone disorder with a strong genetic basis. It is the most common, severe, progressive skeletal illness that has been increasing, particularly in developed countries. Osteoporosis will no doubt constitute a serious clinical burden in healthcare management in the coming decades. The genetics of osteoporosis should be analyzed from both the disease susceptibility and the pharmacogenetic treatment perspectives. The former has been widely studied and discussed, while the latter still requires much more information and research. This article provides a synthesis of the literature on the genetics of osteoporosis and an update on progress made in pharmacogenetics of osteoporosis in recent years, specifically regarding the new molecular targets for antiresorptive drugs. In-depth translation of osteoporosis pharmacogenetics approaches to clinical practice demands a new vision grounded on the concept of "theranostics," that is, the integration of diagnostics for both disease susceptibility testing, as well as for prediction of health intervention outcomes. In essence, theranostics signals a broadening in the scope of inquiry in diagnostics medicine. The upcoming wave of theranostics medicine also suggests more distributed forms of science and knowledge production, both by experts and end-users of scientific products. Both the diagnosis and personalized treatment of osteoporosis could conceivably benefit from the emerging postgenomics field of theranostics.

Academic progression and retention policies of colleges and schools of pharmacy

OBJECTIVE

To describe academic progression and retention policies used by US colleges and schools of pharmacy.

METHODS

Student handbooks on the Web sites of 122 colleges and schools of pharmacy were reviewed between February 2012 and May 2012.

RESULTS

Data were available and obtained from 98 (80%) programs. Most used grade point average (GPA) as a criterion for progression, with 66% requiring a minimum GPA of 2.0. Cumulative GPA was the most frequently used criteria for probation. Most handbooks did not address remediation, but 38% noted that a failed course could only be retaken once. The most common criteria for dismissal were the cumulative number of times a student was on probation. The graduation requirements of most programs were a cumulative GPA of 2.0 and completion of the program within 6 years of enrollment.

CONCLUSIONS

Colleges and schools of pharmacy use various criteria for academic progression and retention and frequently provide incomplete or inadequate information related to probation, progression, and dismissal. Information regarding remediation and academic performance during experiential learning is lacking. A clearinghouse containing institutional data related to progression and retention would assist programs in developing academic policies. The study also highlights the need for ACPE to ensure this information is provided to students.

The impact of pharmacy students' remediation status on NAPLEX first-time pass rates

OBJECTIVE

To determine whether there is a difference in pass rates on the North American Pharmacist Licensure Examination (NAPLEX) between students who did and did not require remediation for deficient course grades.

METHODS

Student-specific data were collected regarding course grade deficiencies and completion of a comprehensive examination or course for remediation. Student-specific first-time NAPLEX performance data for the graduating classes of 2008, 2009, and 2011were provided by the National Association of Boards of Pharmacy (NABP).

RESULTS

A significant difference was found in first-time NAPLEX mean pass rates between students who did not need to undergo remediation versus those who did ( 97% vs 70%).

CONCLUSION

Students requiring remediation for deficient course grades had a lower pass rate on the NAPLEX compared with those who did not require remediation. The difference can be attributed to several factors and therefore further study is needed.