Systematic Review of Predictors of Success for the North American Pharmacist Licensure Examination

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.

Correlating Advanced Pharmacy Practice Experience Exam Scores and Pharmacist Licensure Status in a Single Program

OBJECTIVE

Pharmacist licensure exam first-time pass rates have declined for several years. Predictors of licensure exam performance, including the Pharmacy College Admission Test, are no longer required, necessitating alternative strategies. Our aim is to assess the relationship between numerical scores on advanced pharmacy practice experience (APPE) exams and pharmacist licensure exams first-time pass rates.

METHODS

We conducted a single-center, retrospective, observational analysis. APPE examination results between May 2020 and November 2023 were analyzed for association with licensure information from the Texas State Board of Pharmacy. Exam scores were collected for student cohorts graduating from 2021 to 2022 as study cohort data. Correlation between exam scores and probability of successful licensure was assessed using logistic regression. A classification and regression tree analysis identified the most significant threshold. Predictive ability of the best-fit model was prospectively validated using the 2023 graduate cohort.

RESULTS

The overall licensure success rate was 80.6% for the study cohort (2021-2022, n = 206). Exam scores were well correlated to the likelihood of licensing success. The most significant threshold was 77.8%. The success rate was 82.5% vs 16.7% for those scoring above and below the threshold, respectively. The observed and predicted licensure success rates were 91.0% and 88.8%, respectively, in the validation cohort (2023, n = 89). The positive and negative prediction values were 94.9% and 40.0%, respectively.

CONCLUSION

The performances on APPE exams were reasonable in predicting the first-time licensure success rate for a graduating class. Our assessment appears promising as a risk-stratification tool for students in gaining successful pharmacist licensure.

The impact of critical thinking skills on student pharmacist GPA at a historically Black university

INTRODUCTION

Limited information is available regarding whether malleable factors such as critical thinking skills are associated with academic performance among underrepresented minority pharmacy students. This study assessed the relationship between critical thinking skills and grade point average (GPA) among pharmacy students attending a Historically Black College.

METHODS

A cross sectional study design was utilized to evaluate the association between student's GPA and critical thinking skills. Demographic data and GPA were abstracted from student records. The health sciences reasoning test with numeracy was administered to pharmacy students at Howard University during the 2017 to 2018 academic year. Critical thinking scores were classified as weak, moderate, or strong/superior. A one way analysis of variance was conducted to ascertain if the average GPA differed based on critical thinking skills category. A multiple linear regression analysis was conducted to determine whether student's critical thinking skill category was associated with the cumulative GPA after accounting for other factors.

RESULTS

Among 217 students, the mean GPA among students with a weak critical thinking skills score (3.22 ± 0.40) was lower compared to students with a strong/superior score (3.39 ± 0.33) with a p-value of 0.029. After adjusting for other factors, a strong/superior critical thinking skills score was associated with a higher GPA (p-value = 0.024) in comparison to weak critical thinking skills.

CONCLUSION

Stronger critical thinking skills scores are associated with better academic performance among underrepresented minority pharmacy students.

The North American Pharmacist Licensure Examination (NAPLEX) Pass Rate Conundrum

As first-time pass rates on the North American Pharmacy Licensure Examination (NAPLEX) continue to decrease, pharmacy educators are left questioning the dynamics causing the decline and how to respond. Institutional and student factors both influence first-time NAPLEX pass rates. Pharmacy schools established before 2000, those housed within an academic medical center, and public rather than private schools have been associated with tendencies toward higher first-time NAPLEX pass rates. However, these factors alone do not sufficiently explain the issues surrounding first-time pass rates. Changes to the NAPLEX blueprint may also have influenced first-time pass rates. The number of existing pharmacy schools combined with decreasing numbers of applicants and influences from the COVID-19 pandemic should also be considered as potential causes of decreased first-time pass rates. In this commentary, factors associated with first-time NAPLEX pass rates are discussed along with some possible responses for the Academy to consider.

NAPLEX Preparatory Perceptions from Recent Graduates at One College of Pharmacy

OBJECTIVES

The current study assessed how students prepared for the North American Pharmacist Licensure Examination (NAPLEX), and examined factors associated with first-time pass rates. In addition, updated information on student perceptions of several currently available NAPLEX preparation resources was collected.

METHODS

A survey was administered to 2022 graduates from 1 school, which collected data on student demographics, and NAPLEX-related items regarding when the exam was taken and how students prepared, including resources used. The association between first-time success (pass, no pass) and grade point average (GPA), timing of test date after graduation, effort toward exam, and number of hours studied was examined. In addition, student ratings of NAPLEX preparation resources in terms of usefulness, representativeness to actual examination, and monetary value were reported.

RESULTS

A total of 52 individuals completed the survey. Pharmacy GPA over 3.5, taking the NAPLEX within 60 days of graduation, and exerting moderate to extensive effort to pass the NAPLEX were all associated with higher first-time pass rates. All students reported using at least 1 RxPrep resource, which students rated highly and suggested the school provide as a resource for NAPLEX preparation.

CONCLUSION

This study found that taking the NAPLEX examination within 60 days of graduation, contributing moderate to extensive effort to pass the examination, as well as a cumulative GPA of 3.5 (out of 4) or above were related to success on the NAPLEX. Additionally, students reported high satisfaction with RxPrep resources.

Interrogating Consequential Validity Evidence in NAPLEX Studies Involving the Use of Demographic Variables

OBJECTIVE

to review the purpose, methods, and discussion of student demographics related to North American Pharmacist Licensure Examination (NAPLEX) performance; demographic characteristics, significant findings, and related text were extracted from each reviewed article as evidence of consequential validity.

FINDINGS

Nine articles met the inclusion criteria. Prior degree attainment (n = 8, 88.9%), age (n = 6, 66.7%), race/ethnicity (n = 6, 66.7%), and sex (n = 5, 55.6%) were the most common demographic variables included. One study found that prior degree attainment was negatively related to NAPLEX performance and no studies using this variable discussed their findings. Three studies found significant relationships between age and NAPLEX performance, attributing differences to older students for "unique psychosocial challenges and competing responsibilities" "greater maturity" and being more "professional." Measures of race/ethnicity differed in every study, with 3 reporting significant findings and 2 discussing their findings. Studies referenced literature suggesting that "minority groups" tended to score lower on standardized examinations while others referenced literature that suggests "standardized testing may not be predictive of the performance of minority students." Sex was not related to NAPLEX performance nor was it discussed in any studies.

SUMMARY

Consequential validity evidence is a critical yet underreported aspect of NAPLEX evaluation in pharmacy education. How demographic variables are selected, utilized, and discussed warrants further exploration and consideration by educators, scholars, and practitioners as these decisions can have important sociocultural and political implications.

NAPLEX Preparation Program Characteristics and Resources Associated With First-Time Exam Pass Rates

OBJECTIVE

Pharmacy colleges and schools invest substantial faculty effort and financial resources in North America Pharmacist Licensure Exam (NAPLEX) preparation, including vendor products purported to improve NAPLEX pass rates. The objective of this project was to examine NAPLEX preparation program characteristics associated with first-time pass rates.

METHODS

A national survey investigated which pharmacy schools provided a formal NAPLEX preparation program in the 2021/2022 academic year, and what resources students were required to use. Pharmacy school characteristics and the unique resources provided in NAPLEX preparation programs were separately analyzed for association with 2022 NAPLEX first-time pass rates.

RESULTS

The survey response rate was 71% (100 pharmacy schools). Of the 6 pharmacy school characteristics analyzed, offering a formal NAPLEX preparation program and private status were both weakly correlated with a decrease in the 2022 NAPLEX pass rate, while founding year of 2000 or earlier was weakly correlated with an increase in the pass rate. In a generalized linear model, a decrease in 2022 NAPLEX pass rate was associated with offering a formal NAPLEX preparation program (-5.90% [-11.55 to -0.23]) and with a 3-year accelerated curriculum (-9.15% [-15.55 to -2.75]). Of 12 resources required in NAPLEX preparation programs, 3 were weakly correlated with a decrease in 2022 pass rate: a vendor question bank, vendor review book/materials, and a live, synchronous faculty-led review. In a generalized linear model, a decrease in 2022 NAPLEX pass rate was associated with a live, synchronous faculty-led review (-6.62% [-11.16 to -2.08]). Among schools without a formal preparation program, NAPLEX pass rates consistently exceeded the national average in 2020, 2021, and 2022, while the proportion of schools with NAPLEX preparation programs and first-time pass rates above the national average dropped from 59% in 2021 and 58% in 2020 to 44% in 2022.

CONCLUSION

Simply implementing a NAPLEX preparation program is insufficient to overcome other systemic/programmatic influences of successfully passing the NAPLEX; programs should invest earlier resources to address NAPLEX competencies.

Drug Information Quizzes as Predictors of Student Success in Integrated Pharmacotherapy Courses

OBJECTIVE

To determine if drug quizzes (DQs) can serve as predictors of student success in pharmacy coursework.

METHODS

De-identified student exam and DQ data from 2 courses of the pharmacy curriculum were evaluated over 3 years. One-way analysis of variance, Spearman's rank correlation analysis, and Mann-Whitney U test were utilized to determine significant changes in student performance on exams and DQs over 3 years.

RESULTS

Over 3 years, significant changes in exam performance were accompanied by significant changes in student performance on the respective DQ. A significant positive correlation was observed between student performance on DQ and their scores on respective major examinations in 22 of 24 datasets. Finally, students failing an exam had significantly lower DQ scores compared to students passing an exam in most analyzed datasets across 3 years.

CONCLUSION

Drug quizzes can serve as a predictor of student success or failure in pharmacy courses.

Curriculum mapping of accredited pharmacy programs in the United States

INTRODUCTION

No current guidance exists to inform the content area credit hours for doctor of pharmacy (PharmD) programs in the United States (US).

METHODS

Public websites were accessed for all Accreditation Council for Pharmacy Education (ACPE) accredited PharmD programs in the US to record the credit hours devoted to drug therapy, clinical skills, experiential learning, scholarship, social and administrative sciences, physiology/pathophysiology, pharmacogenomics, medicinal chemistry, pharmacology, pharmaceutics, and pharmacokinetics/pharmacodynamics in the didactic curricula. Due to the high prevalence of programs that integrate drug therapy, pharmacology, and medicinal chemistry into a single course, we subdivided programs based upon whether drug therapy courses were "integrated" or "non-integrated." A regression analyses was conducted to explore the relationship between each content area and North American Pharmacist Licensure Examination (NAPLEX) pass rates and residency match rates.

RESULTS

Data were available for 140 accredited PharmD programs. Drug therapy had the highest credit hours in programs with both integrated and non-integrated drug therapy courses. Programs with integrated drug therapy courses had significantly more credit hours in experiential and scholarship and fewer credit hours in stand-alone courses for pathophysiology, medicinal chemistry, and pharmacology. Credit hours in content areas did not predict NAPLEX pass rate nor residency match success rate.

CONCLUSIONS

This is the first comprehensive description of all ACPE accredited pharmacy schools with credit hours broken down by content areas. While content areas did not directly predict success criteria, these results may still be useful to describe curricular norms or inform the design of future pharmacy curricula.

Comparison of Saudi Pharmacist Licensure Examination (SPLE) Pass Rates by Institution and Applicant Characteristics

In 2019, the Saudi Pharmacist Licensure Examination (SPLE) was first administered to all pharmacy graduates and served as one of the prerequisites for obtaining a pharmacist license. The objective of this study was to evaluate whether institution and applicant characteristics are associated with first-time SPLE success. Passing status for 2284 SPLE first-time applicants was obtained from online public data for the years 2019 and 2020. The data included applicant sex, institution type (public vs. private), and college establishment year (2006 or earlier vs. after 2006). Overall, the SPLE first-time pass rate in 2020 was significantly higher than in 2019 (98.0 vs. 95.9%; p = 0.0062). Applicants from pharmacy colleges established in or before 2006 had a higher SPLE first-time pass rate, compared to those from pharmacy colleges established after 2006 (98.2 vs. 95.2%; p < 0.0001). The pass rate for male applicants was lower compared to female applicants (95.8 vs. 97.5%; p = 0.0221). The results of logistic regression showed that exam year (2020 vs. 2019), applicant sex (female vs. male), and pharmacy college establishment year (≤2006 vs. >2006) were statistically significant predictors. Further studies are needed in the upcoming years when more cumulative data are available.

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.

Multi-institutional Analysis of Student and Program Variables as Predictors of Performance on the NAPLEX

Objective. Understanding student characteristics and risk factors for performance on the North American Pharmacist Licensure Examination (NAPLEX) may help schools and colleges of pharmacy target limited resources. This study aimed to evaluate two sets of Doctor of Pharmacy (PharmD) student variables for their effect on NAPLEX performance.Methods. Data were collected from five schools and colleges of pharmacy over three years (2016-2018). Relationships between variables were first examined with bivariate correlations, and then by a series of multiple regressions using a structural equation modeling approach. Two sets of analyses were conducted using the outcome variable of NAPLEX scaled score. The first set examined variables at admission to the program while the second set examined performance variables during the PharmD program.Results. Students' score on the Pharmacy Curriculum Outcomes Assessment (PCOA) had the highest bivariate correlation with their NAPLEX score, with area 4 and area 2 having the strongest correlations. The correlations of Pharmacy College Admission Test (PCAT) subtest scores with NAPLEX scores were significant but smaller. Admissions variables of incoming science grade point average (GPA) and PCAT area scores were significant predictors of performance on the NAPLEX, but these variables were entered in separate models as they explained the same variance (each approximately 15%). The PCOA area scores and GPA before starting advanced pharmacy practice experiences (pre-APPE GPA) were significant predictors and explained about 25% of the variance in NAPLEX scores.Conclusion Pharmacy students' PCOA area scores and pre-APPE GPA were significant predictors of their NAPLEX scores. Information in this study can be used by pharmacy schools to efficiently target support services to students for enhanced NAPLEX performance.