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

DISCUSSION

In two cohorts of graduates from a private four-year program, students with two or more summer remediations were less likely to pass the NAPLEX on the first attempt and had significantly lower NAPLEX scaled scores when compared to students with no remediations. A single course remediation was not associated with a reduced NAPLEX first-attempt pass rate.

Palmer and colleagues most recently examined NAPLEX pass rates in students at an accelerated three-year program who completed remediation between quarters compared to students who did not require remediation and did not have to repeat a course.⁴ Their analysis found lower NAPLEX performance for students who remediated or repeated multiple courses but no difference for students who remediated only one course. Although the timing of when remediation occurred varied, our analysis identified a similar association of the impact of a singular remediation versus multiple remediations on NAPLEX outcomes, suggesting that remediation as an intervention for single course deficiencies may be acceptable. Other literature has suggested a relationship between pre-NAPLEX scores and the need to remediate a course as a binary outcome; however, we suggest that future researchers use multiple categories to classify remediation frequency (eg, zero, one, two or more) to potentially improve predictive value.⁵

In comparison to our report, previous works on remediation do not stratify remediation data by year or by course content type. Our data showed that the number of remediations in P2 and P3 negatively correlated with NAPLEX scaled score, whereas remediation in P1 did not. Possible reasons for this finding could include survival bias (students who remediate in P1 may be less likely to graduate), an underpowered sample size, timing that is too distant from the NAPLEX to be predictive, or the course content in P1 is less applicable to the NAPLEX blueprint.

Related to course content, remediating courses mapped to PCOA area 4.0 (clinical sciences) and those with mixed PCOA content areas were negatively correlated with NAPLEX scaled scores. Remediation of courses mapped to other PCOA areas were not significantly correlated; however, because remediation was less common in these other areas, analysis may have been underpowered. Regardless, these findings are perhaps expected given the NAPLEX blueprint emphasis on clinical sciences.

In concept, a “successful” remediation is intended to indicate that a student has corrected an academic deficiency and has mastered the material for a course equivalently to a student who passed the course without remediation. The findings from this report and Palmer and colleagues suggest that students who require multiple remediations may have a weaker knowledge base upon graduation, as measured by NAPLEX, compared to their peers with fewer remediations. These implications warrant further research regarding how remediation is conducted and how mastery of the course material can be appropriately measured.

These findings also validate the need for additional support and interventions for those qualifying for remediation but particularly in those remediating several courses. Individualized remediation plans and student-directed remediation to include readings, assignments, practice problems, and discussion could all be considered for more supportive remediation approaches. Additionally, schools and colleges of pharmacy may need to consider these findings when drafting student progression policies, such as remediation limits, or in advising a student with academic difficulties. The ACPE does not currently prescribe the specifics of remediation policies or remediation limits, but given the relationship between remediations and NAPLEX performance, programs should consider evaluating their current process to ensure that remediation is accomplishing its desired outcome.¹ Survey data indicate significant heterogeneity in remediation practices among schools and colleges of pharmacy, which is likely a result of the lack of high-quality data to support a specific approach as highlighted in a recent systematic review.^6,7

There are limitations to this study. We excluded students who did not have remediation or NAPLEX data; therefore, students who remediated and were dismissed or withdrew prior to graduation were not included and may introduce a survival bias. This bias would have also contributed to a falsely elevated remediation pass rate, as those who do not pass remediation would have had delayed progression or left the program. Additionally, students who matriculated prior to 2014 (in which remediation data was systematically collected) or those who did not take the NAPLEX within the time frame of our study were also excluded. Finally, as remediation practices vary nationally, results from our four-year program with summer remediation may not be applicable to institutions with alternative academic structures. An area of future research is to better understand the optimal approach to remediation and accurately evaluate students’ competency of course content. At the time of this publication, schools and colleges are no longer provided student-level NAPLEX pass rates nor scaled scores; therefore, future studies may need to focus on other standardized exams that are correlated with NAPLEX success, such as the PCOA or pre-NAPLEX exams.