As spring semesters come to an end, fourth-year PharmD students around the country have begun crossing graduation stages, collecting their diplomas, and beginning the transition from students to pharmacists. But before they can officially enter the workforce, they have one more hurdle to navigate, the NAPLEX.
The North American Pharmacist Licensure Exam also known as the NAPLEX was developed by the National Association of Boards of Pharmacy (NABP) to evaluate the general practice knowledge and determine the licensure eligibility of recent Doctor of Pharmacy graduates. This past year, the University of Arizona College of Pharmacy scored a 94.85% with their first-time pass rates. This score demonstrates an increase of more than 10 percentage points from their 2018 score and, most notably, is more than 6 percentage points higher than this year’s national average. This achievement would be remarkable in a normal year, but with a global pandemic compounding everyday interactions in healthcare, this feat has taken on a new level of significance.
Responding to Change
In 2016, NABP made some changes to the exam, including to the format. The test went from an adaptive delivery to a fixed-form exam increasing the number of questions from 185 to 250 and the duration of the test from 4.5 hours to 6. This and other changes correlated with a decline in pass rates nationwide with the average reaching below 80% in 2017.
The UArizona College of Pharmacy was not immune to these declines, and set out to identify ways they could help their graduates achieve success on the newly structured test.
“I created a task force to help us diagnose what was happening and to determine how we could fix it,” described Terri Warholak, PhD, assistant dean of academic affairs and assessment for the College. “I wanted to make sure we were taking into consideration several points of view and experiences and speaking to people who had graduated from different schools of pharmacy.”
The task force, a group of faculty and staff members from across the College, began to notice several themes that were associated with poor NAPLEX performance including study skills that did not promote long-term memory, cramming for the exam, and a general lack of time as well as a framework for studying 4 years’ worth of material. The group also reached out to their peer institutions to see what had been successful elsewhere and what they should avoid.
“We heard everything from schools having one study session at the very end of fourth year to requiring monthly exams throughout the student’s fourth year,” explained Ashley Campbell, PharmD, assistant professor and a member of the NAPLEX task force. “We wanted to come up with something that was a happy medium while providing flexibility for some personalization.”
Starting in 2018, the task force set to work addressing these issues through a variety or strategies. To begin with, they developed resources to educate students on study skills that helped to increase long term memory. The team also moved the pre-NAPLEX practice exam up from the students’ 4th year to their 3rd. This change gave the students a self-assessment tool early on to help inform their study plan and identify areas needing improvement.
“We wanted them to be able to reflect on their performance areas for growth and be thinking about how they want to implement a study plan for their fourth year,” explained Dr. Campbell. “And ideally be able to align that study plan with their fourth-year rotations to get them excited about it too.”
The task force also obtained funding through the Dean’s office to provide the RxPrep program to all fourth-year students. The program includes a comprehensive study guide, 88 online review lecture videos, and a 3,000-item test bank. In the first year of the project, students were encouraged to study using RxPrep, but it was not mandatory or tied into their graduation requirements. That year, pass rate scores increased by more than three percentage points, a significant jump. Still, the group knew that more could be done.
In 2019, the group set a designated study schedule for students for the year before the exam, used the RxPrep test bank to create tests covering the most missed topics on the NAPLEX exam, and established points for passing each review exam to ensure accountability. These new requirements meant that students were held accountable for reviewing the content much earlier in the year and in a testing format that resembled the NAPLEX. This new approach helped to successful connect the real-world experience students were facing during their rotations with the didactic coursework they had covered previously.
“For certain Advanced Pharmacy Practice Experience (APPE) rotations I would review relevant RxPrep chapters. When it was closer to my NAPLEX test date, I reviewed biostatistics, calculations, and any topics that I felt I needed to brush up on,” explained Ann Shangraw, PharmD, from the class of 2020. “I liked the practice questions because during your APPE rotations you basically go a year without completing an exam. It was nice to test myself in terms of knowledge and speed.”
“I think the RxPrep program was extremely beneficial,” noted Hunter Hoffman, PharmD, from the class of 2020. “It was nice to have a succinct book with all of the knowledge in one place to refer to as opposed to having to go through all of my old notes.”
While the college is celebrating, the task force and Dr. Warholak set their sights on a new goal. “We don't want to get complacent over where we are right now,” said Dr. Campbell. “I think we can celebrate our victories but continue to work toward the goal of a one hundred percent first time NAPLEX pass rate.”
Members of the task force included: Ashley Campbell, PharmD; Terri Warholak, PhD; Nancy Alvarez, PharmD; Caitlin Cameron, PharmD; Barb Collins, MS; Janet Cooley, PharmD; Lisa Davis, PharmD; Jeannie Lee, PharmD; Aaron Middleton, PharmD; Marian Slack, PhD; Amy Kennedy, PharmD, and Liz Coronado.