North American Pharmacist Licensure Examination Research Articles

Response to Comment on “Falling pass rates on the North American Pharmacist Licensure Examination signal an emerging crisis for a growing number of pharmacy schools”

Response to <scp>Comment</scp> on “<scp>Falling</scp> pass rates on the <scp>North American Pharmacist Licensure Examination</scp> signal an emerging crisis for a growing number of pharmacy schools”

Comment on “Falling pass rates on the North American Pharmacist Licensure Examination signal an emerging crisis for a growing number of pharmacy schools”

Comment on “Falling pass rates on the North American Pharmacist Licensure Examination signal an emerging crisis for a growing number of pharmacy schools”

Redesigned Entrustable Professional Activity (EPA) Assessments Reduce Grade Inflation in the Experiential Setting

ObjectiveThis study aims to evaluate the impact of redesigning an entrustable professional activities (EPAs) assessment tool on the accuracy of student performance assessment within pharmacy education. MethodsThe study used retrospective programmatic data for students on clinical rotations over a 3-year period and compared entrustment levels assigned by preceptors with suggested entrustment levels. This tool was redesigned to separate formative EPA feedback from final grade determination. Data were analyzed using chi-squared tests to identify trends in students ABOVE, AT, or BELOW the suggested entrustment levels. Additionally, to account for intercohort variability, the relationship between students ABOVE the suggested level of entrustment and postgraduate metrics was examined. ResultsAfter the implementation of the revised tool, there was a significant decrease (−3%) in the percentage of students scoring ABOVE the suggested entrustment levels and an increase in the percentage of students scoring AT (+1%) or BELOW (+2%) the suggested entrustment levels. Changes were also observed in individual patient care settings, with a decrease in grade inflation and an increase in accurate assessments. North American Pharmacist Licensure Examination (NAPLEX) pass rates, residency match rates, and grade point average did not correlate with entrustment levels. ConclusionThe redesigned EPA assessment tool demonstrated a decrease in grade inflation resulting in more accurate assessments. The tool’s focus on holistic grading and narrative descriptors contributed to better alignment between preceptor assessment and school-suggested achievement levels. This study suggests that EPA assessments in pharmacy education could benefit from a stronger emphasis on formative feedback and the use of holistic assessment methods for final grade determinations. The findings underscore the potential advantages of considering a separation between EPA scoring and final grades, prompting the Academy to explore their assessment practices to better reflect student performance in clinical experiences.

Prospective healthcare students' perspectives and attitudes on pharmacy as a chosen career path

BackgroundWith the national increase in the number of colleges and schools of pharmacy as well as the decreased pharmacy school applicant pool in recent years, pharmacy school enrollment challenges are at the forefront of issues facing pharmacy programs today. Factors that can influence a candidate's likelihood to pursue pharmacy school are important to evaluate. Recent studies assessing factors that motivate potential pre-health candidates to pursue pharmacy school or other healthcare careers are limited. ObjectiveTo describe prospective candidates' perspectives and attitudes toward pharmacy as a career pathway and assess factors that motivate or deter them from pursuing pharmacy as a career and from considering a specific pharmacy school. MethodThe study was cross-sectional and used an online data collection form distributed via the Qualtrics platform from October 4, 2022 through October 12, 2022 using the social media platform Reddit. Reddit has hundreds of subcommunities known as subreddits, that allow for exchange of ideas and discussion regarding various topics. This social media platform is commonly used by pre-health students to discuss career options. The survey consisted of 28 items and two domains, demographics and prospective healthcare students' understanding of responsibilities of pharmacists and their overall perspective on pharmacy as a profession. The survey was targeted toward anyone with an intention of pursuing a health science degree or career. ResultFour hundred participants completed the survey. Participants were mainly Caucasian, male, and with a mean age of 25 years. This study assessed prospective candidates' perspectives and attitudes toward pharmacy as a career pathway, appealing and unappealing characteristics about pursuing a career in the field of pharmacy, and factors that motivate or deter candidates from pursuing pharmacy. While 68 % of the participants had heard that career choices are vast and vary in the field of pharmacy, most still had concerns about the pharmacy field being heavily saturated and lack of job opportunities after graduation. Almost 60 % of responders gained information about pharmacy programs through social media platforms. The North American Pharmacist Licensure Examination pass rate, postgraduate residencies/fellowships, program duration and program reputation were among the top factors in choosing a pharmacy program. ConclusionMany survey participants had heard that there are a variety of job opportunities in the field of pharmacy, but the majority had heard that the pharmacy field is heavily saturated and that there are lack of opportunities after graduation. Most responders gained information through social media platforms. For prospective pharmacy school candidates, NAPLEX pass rate, number of graduates matched with PGY1 residencies and fellowships, and duration and reputation of the program seems to be among the most important factors in choosing a pharmacy program. Factors that prospective candidates consider when selecting a pharmacy program and the means they use to research about programs can be important considerations for pharmacy programs recruitment. Awareness of the preferences and baseline knowledge of candidates about the field of pharmacy can aid in developing targeted recruitment strategies and informing decision-making in pharmacy programs and recruitment efforts.

Large Language Models and the North American Pharmacist Licensure Examination (NAPLEX) Practice Questions

ObjectiveThis study aims to test the accuracy of large language models (LLMs) in answering standardized pharmacy examination practice questions. MethodsThe performance of 3 LLMs (generative pretrained transformer [GPT]−3.5, GPT-4, and Chatsonic) was evaluated on 2 independent North American Pharmacist Licensure Examination practice question sets sourced from McGraw Hill and RxPrep. These question sets were further classified into binary question categories of adverse drug reaction (ADR) questions, scenario questions, treatment questions, and select-all questions. Python was used to run χ2 tests to compare model and question-type accuracy. ResultsOf the 3 LLMs tested, GPT-4 achieved the highest accuracy, with 87% accuracy on the McGraw Hill question set and 83.5% accuracy on the RxPrep question set. In comparison, GPT-3.5 had 68.0% and 60.0% accuracy on those question sets, respectively, and Chatsonic had 60.5% and 62.5% accuracy on those question sets, respectively. All models performed worse on select-all questions compared with non-select-all questions (GPT-3: 42.3% vs 66.2%; GPT-4: 73.1 vs 87.2%; Chatsonic: 36.5% vs 71.6%). GPT-4 had statistically higher accuracy in answering ADR questions (96.1%) compared with non-ADR questions (83.9%). ConclusionOur study found that GPT-4 outperformed GPT-3.5 and Chatsonic in answering North American Pharmacist Licensure Examination pharmacy licensure examination practice questions, particularly excelling in answering questions related to ADRs. These results suggest that advanced LLMs such as GPT-4 could be used for applications in pharmacy education.

Counting on Change: Conquering Challenges in Teaching Pharmaceutical Calculations

All pharmacists are expected to accurately perform pharmaceutical calculations to ensure patient safety. In recent years, there have been trends in declining performance on the North American Pharmacist Licensure Examination related to calculations. Understanding the cause of this decline and determining methods to correct underlying issues could benefit pharmacy administration, faculty, students, and patients. The aims of this commentary are to present the factors impacting the students’ pharmaceutical calculations abilities, discuss the consequences of declining math skills, and provide a call to action for scholarship of teaching and learning pertaining to calculations, as well as increased administrative support to rectify this challenge.

Falling pass rates on the North American Pharmacist Licensure Examination signal an emerging crisis for a growing number of pharmacy schools

AbstractThe North American Pharmacist Licensure Examination (NAPLEX) is a major assessment metric for graduates pursuing licensure and the institutions from which they graduated. Before 2014, the mean NAPLEX first‐time pass rate was roughly 95% every year. Mean pass rates have fallen dramatically since then to less than 80%, with many schools currently unable to achieve a 70% pass rate. Such a drastic decline in NAPLEX performance constitutes a crisis for many schools. Changes to the exam blueprint, administration, and scoring provide a partial explanation for the decline, but the issue of cause ultimately comes down to one simple question: What has changed over the last 10 years that is making it more difficult for graduates to pass NAPLEX on the first attempt? The effects of excessive academic expansion, beginning in 2000, cannot be overlooked. The newest schools, established after 2009, and accelerated (3‐year) programs, many of which are also new, appear to be particularly vulnerable. In 2023, 16 pharmacy schools had first‐time pass rates below 65%. Nine (56%) of those schools opened after 2009 and seven (44%) were accelerated programs. Newer schools have had to compete for a limited supply of qualified faculty, administrators, preceptors and experiential training sites, while also striving to meet enrollment targets amid a dwindling applicant pool. The ability to overcome the NAPLEX crisis depends on first establishing a more effective process of assessing NAPLEX results—one that measures the right metrics in the right way—and upholds fair, but rigorous, quality standards. Stakeholders need access to actionable information and the most relevant, useful data available. The purpose of this article is to provide evidence that the Academy is facing a legitimate crisis and offer four recommendations by which assessment and understanding of the crisis can be enhanced.

Educational outcomes necessary to enter pharmacy residency training: 2023 update

AbstractThe 2023 Educational Affairs Committee reviewed relevant position statements and publications to update the 2014 ACCP position statement on the educational outcomes (EOs) necessary for pharmacy students to enter postgraduate year 1 (PGY1) residency training. The committee initially aligned entry‐level graduate outcomes with current PGY1 residency competencies achieved after postgraduate training. The committee then used these alignments to identify consistencies, insufficiencies, and gaps in preparation. This process revealed that the EOs and entrustable professional activities from curricular outcomes and entrustable professional activities and the North American Pharmacist Licensure Examination blueprint could serve as a partial list of outcomes necessary to enter postgraduate training; however, some of the outcomes necessary to enter residency were not consistently addressed. To improve residency readiness, the committee recommends that both academic programs and the individual learner evaluate and seek opportunities to address any curricular gaps in alignment. The findings also underscore the need for a single set of well‐defined and mutually agreed‐on educational competencies that evolve over time and embrace the knowledge, skills, and attitudes that demonstrate residency readiness.

High Total Failures of the North American Pharmacist Licensure Examination (NAPLEX) Warrant Monitoring of Professional Pharmacy Programs

From 2021 to 2023, 7978 graduates of pharmacy programs failed the North American Pharmacist Licensure Examination on the first attempt. Presently, the Accreditation Council for Pharmacy Education monitors programs with a passage rate of ≥ 2 SDs below the national mean pass rate. In 2023, this should lead to monitoring 7 programs that produced 140 failures out of the total of 2472 failures (5.7 %). In our view, this is neither equitable nor demonstrative of sufficient accountability. Analysis of failure counts among the 144 programs reported by the National Association of Boards of Pharmacy demonstrates a distribution curve highly skewed to the right. The evaluation of average failure counts across all programs suggests that schools with absolute failures ≥ 2 SDs higher than the average number of failures should be identified for monitoring, in addition to those falling ≥ 2 SDs below the national mean pass rate. Based on the 2023 data, this additional criterion corresponds to ≥ 35 failures/program. This threshold would prompt monitoring of 18 programs and 36.5 % of the total failures. Of the 7 programs that will be monitored based on the current Accreditation Council for Pharmacy Education criteria, only 1 would be captured by the ≥ 35 failure method of selection; the remaining 6 contribute 85 total failures to the pool. Thus, if both criteria were to be applied, ie, ≥ 35 failures and ≥ 2 SDs below the national mean pass rate, a total of 24 programs would be monitored (16.6 % of the 144 programs) that contribute 987 of the total failures (39.9 %).

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.

A Description of Required NAPLEX Preparation Courses Among US Pharmacy Programs

ObjectiveOne of the final tasks for pharmacy graduates to enter practice is passing the North American Pharmacist Licensure Examination (NAPLEX). Given the recent national declines in pass rates, programs are making significant investments of time and money in NAPLEX preparation. The objective is to characterize the structure and content of required NAPLEX preparation courses. MethodsA survey on NAPLEX preparation practices was developed and distributed to all Accreditation Council for Pharmacy Education-accredited pharmacy schools. NAPLEX preparation course syllabi were also collected as part of this survey. Syllabus information was summarized into 4 elements: course structure, content, resources, and assessment strategies. ResultsOf 144 colleges/schools of pharmacy, 100 responded to the survey, 87 reported having a NAPLEX preparation program, and 47 reported having a NAPLEX preparation course. Twenty syllabi were collected. Most courses (14) were longitudinal through the Advanced Pharmacy Practice Experiences year, 16 were credit-bearing, and 19 included a vendor NAPLEX preparatory product. Fourteen courses were hybrid delivery, and 12 focused on licensure preparation and included test-taking strategies, calculations practice, case-based discussions, etc. All 20 courses reported using unproctored timed quizzes and practice examinations, half conducted proctored timed assessments, and 11 included written reflections and/or continuous professional development activities. Most courses were pass/fail (15), and high stakes (16) were defined by delayed or withheld graduation as a consequence for failure. Only 3 of 20 NAPLEX preparation courses were mapped to NAPLEX competencies. ConclusionAlthough required NAPLEX preparation courses focus on assessments, the content is infrequently mapped to NAPLEX competencies. This project provides some information on how schools might create their own NAPLEX preparatory courses.

Impact of curricular and institutional factors on Pharm.D. students' NAPLEX success: A comprehensive analysis of US pharmacy programmes

Background: Curricula and institutional factors in pharmacy schools play a pivotal role in shaping students' readiness for the North American Pharmacist Licensure Examination (NAPLEX). The factors that influence student success remain uncertain. This research explores the association between various aspects of pharmacy school curricula and NAPLEX pass rates. Methods: Data on various aspects of pharmacy programs across the United States were collected, including curricular structure and content. Multiple linear regression analysis was conducted to investigate the correlation of factors with NAPLEX pass rates. Results: The four-year programmes and research-focused institutions, with a curricular emphasis on practice management, pharmacology, pharmacotherapy, and APPE, had a positive relationship with NAPLEX pass rates. Focus on Pharmaceutical Calculations had a negative relationship with NAPLEX performance. All other factors were non-significant. Conclusion: This study provides valuable insights into the determinants of NAPLEX pass rates. It underscores the importance of a well-rounded curriculum and a balanced course selection to enhance student performance.

NAPLEX Preparatory Perceptions from Recent Graduates at One College of Pharmacy

ObjectivesThe 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. MethodsA 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. ResultsA 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. ConclusionThis 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.

Monitoring of schools and colleges of pharmacy based on NAPLEX passage rate

IntroductionWe have evaluated two approaches of monitoring schools and colleges of pharmacy based on North American Pharmacist Licensure Examination (NAPLEX) passage rates. Historically, the Accreditation Council for Pharmacy Education (ACPE) has cited programs for passage rate ≥2 SD below the national average. Since the National Association of Boards of Pharmacy (NABP) no longer reports scores, this procedure is being reconsidered. Our supposition is that the failure rate of ≥2 SD below the average should be retained, but now be based on the national average passage rate rather than score. Yet, we further suggest this is not sufficient due to major variations in class size. CommentaryWe suggest the establishment of a “maximum acceptable failure count,” likely in the range of 20 to 25 failing graduates per class. Analyses of data from 2017 to 2019 indicate that this approach would lead to monitoring approximately 15% of existing programs that graduate approximately 40% of individuals failing NAPLEX vs. monitoring only 5% of programs that graduate approximately 9% of individuals failing NAPLEX. ImplicationsThe historical method of monitoring pharmacy programs with NAPLEX passage rates ≥2 SD below the national average is not sufficient, primarily due large variations in class size. Since accreditation standards are currently being revised (“Standards 2025”), this would be an ideal time to update methods for selecting programs that warrant monitoring based on inadequate NAPLEX passage rates. We suggest the concept of “maximum acceptable failure count” should be considered when identifying programs to be cited.

Final-Year Pharmacy Students Experiences of a New North American Pharmacist Licensure Examination® (NAPLEX®) Preparation Module

Final-Year Pharmacy Students Experiences of a New North American Pharmacist Licensure Examination® (NAPLEX®) Preparation Module

Curriculum mapping of accredited pharmacy programs in the United States

IntroductionNo current guidance exists to inform the content area credit hours for doctor of pharmacy (PharmD) programs in the United States (US). MethodsPublic 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. ResultsData 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. ConclusionsThis 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.

Association Between Accreditation Era, North American Pharmacist Licensure Examination Testing Changes, and First-Time Pass Rates

Objective. To estimate whether first-time pass rates on the North American Pharmacist Licensure Examination (NAPLEX) have been influenced by the number of pharmacy programs founded since 2000, the programs' accreditation era, and the changes to the blueprint as well as changes to the testing conditions and passing standards implemented by the National Association of Boards of Pharmacy (NABP) beginning in 2015.Methods. This was a retrospective, observational cohort study using publicly published data. The number of programs and pass rates were collected from 2008 to 2020. Programs reporting pass rates from 2016 to 2020 were eligible. Accreditation era was defined as programs accredited before or after 2000. Pass rates were categorized into NAPLEX tests administered before or after 2015. Statistical analyses were conducted for comparisons.Results. Pass rates were initially found to decline as the number of programs rose. First-time pass rates of programs accredited before 2000 were higher than pass rates of programs accredited after 2000 every year after 2011. Only 40% of the programs accredited after 2000 exceeded the national average between 2016-2020. Blueprint changes implemented in 2015 and the changes to testing conditions plus passing standards implemented in 2016 had a greater effect on pass rates than the number of programs or applicants.Conclusion. Programs accredited after 2000 generally had lower first-time NAPLEX pass rates. Even so, blueprint changes and changes to the testing conditions plus passing standards instituted by the NABP were more important predictors of the decline of first-time NAPLEX pass rates. Stakeholders should collaborate and embrace best practices for assessing practice-ready competency for licensure.

A Description of NAPLEX and MPJE Preparation Strategies Among US Colleges and Schools of Pharmacy

ObjectiveThe purpose of this study was to describe the different strategies used to supplement North American Pharmacist Licensure Examination (NAPLEX) and Multistate Pharmacy Jurisprudence Examination (MPJE) preparation in the US pharmacy programs. MethodsAn online survey was developed to gather information from 141 accredited schools/colleges of pharmacy about the preparation methods used during the 2021–22 academic year. The questionnaire contained 19 NAPLEX- and 10 MPJE-specific questions related to timing, content, use of commercial products and programs, faculty involvement, and whether these activities were required or recommended. Characteristics of schools/colleges were compared based on the presence or absence of preparation programs; preparation programs were descriptively reported. ResultsThe response rate was 71%. Most schools (87/100 respondents) provided NAPLEX preparation programs starting in the advanced pharmacy practice experiential year, required students to participate, and focused on reviewing the content instead of assessing students’ examination readiness. Similar elements were reported among 61 schools providing MPJE preparation programs. Schools used a variety of resources including access to vendor-based question banks or review materials, and completing live, proctored, NAPLEX-like examinations. Characteristics of schools or colleges did not differ significantly based on presence or absence of a preparation program. ConclusionSchools/colleges of pharmacy use a variety of strategies to prepare students for licensing examinations. Many require student participation in vendor-based preparation programs for NAPLEX, and homegrown programs for MPJE preparation. The next step will be to determine the effectiveness of various approaches used by the schools/colleges on first-time licensure examination attempts.

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.

Impact of medicinal chemistry integration in Pharm.D. programmes on first-time NAPLEX pass rates

Objectives: To address the impact of instructing medicinal chemistry in an integrated versus stand-alone fashion on three-year average of first-time NAPLEX (North American Pharmacist Licensure Examination) pass rates of all United States of America Pharmacy programmes. Methods: A review of each programme’s publicly available curriculum on their official webpage revealed medicinal chemistry as integrated (horizontal or vertical), or standalone course forms. Fisher’s exact and the ANOVA tests were performed to assess the primary outcome and covariates. Results: Out of a total of 136 eligible programmes, 80 programmes (61.5%) stated that medicinal chemistry content was integrated with other foundational sciences content (‘horizontal integration’), while 38 (29.2%) stated that medicinal chemistry was a standalone course. Medicinal chemistry is integrated with pharmacotherapy courses ('vertically integrated’) in remaining 12 programmes (9.2%). Conclusion: A conclusion could not be made regarding the impact of medicinal chemistry instruction on NAPLEX outcome due to other underlying factors; however, this study provided a framework for future research.