Abstract
Objective. Pharmacy programs have struggled to predict who will be successful in their programs based solely on cognitive skills. The primary objective of this study was to determine which, if any, nonacademic factors are associated with on-time progression within the school of pharmacy curriculum.
Methods. A survey was developed and offered to all Texas Tech University Health Sciences Center Jerry H. Hodge School of Pharmacy students in fall 2020. This survey included questions to collect demographic data and incorporated four validated questionnaires: the Grit-Grid, the Academic Pharmacy Resilience Scale (APRS-16), the Cohen Perceived Stress Scale (CPSS), and the Turkish Time Management Questionnaire (TTMQ).
Results. Completed surveys were submitted by 213 students out of 569 (37.4% response rate). On-time progression rate was calculated separately for each class. Through binary logistic regression, we found that on-time progression was significantly associated with prepharmacy grade point average >3.20, high school Grit-Grid score >0.9, APRS-16 score >35, and CPSS score >34. Pharmacy College Admission Test (PCAT) composite scores and admissions committee rubric scores were not associated with on-time progression.
Conclusion. Based on the results of this study, it may be reasonable to implement the Grit-Grid, APRS-16, and the CPSS in the admissions process to help determine the most appropriate candidates for our program or use them as screening tools for incoming students to identify who may be at academic risk. However, these factors need to be validated in pharmacy programs in other private and public universities before widespread adoption can be condoned.
INTRODUCTION
Past studies have observed positive correlations between Pharmacy College Admissions Test (PCAT) scores and prepharmacy grade point averages (PPGPA) with the successful completion of pharmacy school.1,2 At the Texas Tech University Health Sciences Center Jerry H. Hodge School of Pharmacy program, the admissions committee had previously developed an admission scoring rubric, which included an applicant’s PCAT composite score, PPGPA, number of prepharmacy courses dropped, and interview score. However, this rubric predicted on-time completion only 40% of the time. The number of applications per school of pharmacy has declined significantly over the last 17 years from 1001 per school in 2004 to 268 per school in 2021, increasing competition for the best candidates.3 As competition has increased, several programs no longer require the PCAT examination for entrance.4
There is some evidence to suggest that individual nonacademic factors, such as perseverance, resilience, extracurricular involvement, manageable stress levels, and time management, correlate with college success and better performance within health-related professions.5-10 To our knowledge, a comprehensive evaluation of whether nonacademic factors affect success in pharmacy programs has not been performed. The objective of this study was to evaluate several nonacademic factors in a systematic fashion and determine whether any of them predict on-time program progression.
METHODS
On-time progression rate was calculated separately for each class based on completed semester credit hours divided by the required semester credit hours at the end of the spring 2021 semester: first year=39 semester credit hours, second year=80 semester credit hours, third year=118 semester credit hours, fourth year=169 semester credit hours.
Nonacademic factors were measured using four assessment tools. First, to measure grit and perseverance, we used the Grit-Grid developed by Duckworth.11 The assessment tool asks about a student’s extracurricular involvement in high school and during undergraduate education and is scored as follows: engagement in an extracurricular activity for two or more years was awarded one Grit-Grid point; engagement in an extracurricular activity for only one year was awarded no points and, thus, advanced achievements in those activities were not scored. Some kind of advancement in an activity earned the student a second Grit-Grid point, and when the advancement could reasonably be deemed “high” versus “moderate,” a third Grit-Grid point was awarded. The investigators independently scored the Grit-Grid information provided by the students based on Duckworth’s instructions.11 The Grit-Grid score range for this study was zero to six. Krippendorff alpha was used to calculate the interrater reliability of the scoring. The mode of the Grit-Grid scores for each participant was used in all other quantitative analyses.
Next, we measured academic resilience using the Academic Pharmacy Resilience Scale (APRS-16).12 The APRS-16 is a 16-item score derived from a 30-item academic resilience scale as well as the Short Grit Scale (GRIT-S).
Students’ response to stress was measured using the Cohen Perceived Stress Score (CPSS), a validated 14-point questionnaire. The CPSS measures how stressful a person perceives a life situation.13
Finally, time management was measured with the Turkish Time Management Questionnaire (TTMQ).14 The TTMQ is a 27-item assessment with questions divided among three categories: time management, time attributes, and time wasters.
To conduct the study, a survey tool was developed and offered to all Jerry H. Hodge School of Pharmacy students in fall 2020. The survey included questions to obtain demographic information: age on admission, sex, race/ethnicity, campus matriculation, and prepharmacy degree information (eg, university type, major, and bachelor’s degree attainment). The assessment tools outlined above were also included within the survey. The students were sent an invitation email from Qualtrics (Qualtrics International Inc), asking for their participation in the survey and directing them to a website to complete it. At periodic intervals, several follow-up emails were sent to the students who had not yet completed the survey. Completing the survey was voluntary, and informed consent was requested before students began the survey. A staff person documented all the students’ data required for the study but deidentified the data before submitting it to the researchers. As an incentive, the names of students who volunteered to complete the survey were placed into a drawing for one $100 gift card per class.
Data collected included PCAT scores, PPGPA, overall college grade point average (GPA), admission rubric scores, and the survey data, and we also collected data that helped gauge students’ progression through the curriculum. All data were exported into a Microsoft Excel spreadsheet and were evaluated with the statistics add-on package Analyse-it version 5.68 (Analyse-it Software Ltd) for Microsoft Excel. The primary outcome was evaluated with binary logistic regression analysis, using the factors mentioned in the methods. Any factor with a p>.2 was eliminated from the analysis model. When significant associations were found with binary logistic regression analysis, univariate analysis was conducted further. Continuous data were evaluated with the Shapiro-Wilke test for normality, and the median with interquartile range were used for nonparametric data to represent central tendency and dispersion. Nonparametric comparisons used Mann-Whitney and Wilcoxon tests as appropriate. Nominal data used chi-square tests for differences as appropriate. Alpha was set a priori at <.05. The study was approved by the institutional review board at Texas Tech University Health Sciences Center.
RESULTS
Completed surveys were received from 213 of 569 students (37.4%) with similar response rates among the classes. The most recent on-time progression rate was conducted in June 2021 (after the end of the spring 2021 semester); data from 211 students were used to calculate the rate. Two students decided to take a leave of absence for the spring 2021 semester and were excluded. Table 1 shows demographic and academic information and progression. The average student was a White, 22-year-old female who completed a bachelor’s degree from a four-year institution prior to pharmacy school.
Demographic and Academic Data in On-Time Versus Not On-Time Progression of Pharmacy Students
On-time progression for each class was as follows: first-year students=90.5% (38/42), second-year students=84.7% (50/59), third-year students=84.6% (44/52), and fourth-year students=79.3% (46/58; p=.51). There were no significant differences in on-time progression based on having a bachelor’s degree, the source of prerequisites, the PCAT composite score, PCAT component scores, or the school’s admissions committee rubric score.
Table 2 summarizes various individual factors and combinations of factors on progression. Several factors were associated with on-time progression, including PPGPA>3.2, high school Grit-Grid score>0.9, APRS-16>35, CPSS>34, and TTMQ>55. When a student had a PPGPA>3.2, a high school Grit-Grid score>0.9, APRS-16>35, and CPSS>34, there was a 100% (25/25) chance of being on time, whereas for students with a PPGPA≤3.2, a high school Grit-Grid score≤0.9, and APRS-16≤35, there was only a 20% (one in five) chance of being on time (p<.001). The strongest factors predicting on-time progression were a PPGPA>3.2 and a high school Grit-Grid score>0.9. If a student had a PPGPA>3.2 and a high school Grit-Grid score>0.9, they had a 92.9% (91/98) chance of being on time, and if both were negative, there was only a 38.5% (five of 13) chance of being on time (p<.001). Table 3 summarizes the binary regression model. Significant factors predicting on-time progression were PPGPA>3.2, high school Grit-Grid>0.9, CPSS>34, and APRS-16>35. Odds ratios for on-time progression ranged from 2.84:1 (CI=1.23-6.53) for APRS-16>35 to 4.55:1 (CI=1.92-10.77) with PPGPA>3.2. The overall model was significant with a G2 statistic of 30.68 and p<.001.
Factors and On-Time Progression Among Pharmacy Students (N=211)
Binary Regression Model for On-Time Progression in Pharmacy Students (N=211)
DISCUSSION
This study evaluated several nonacademic factors to determine whether those factors would predict on-time progression through the Texas Tech University Health Sciences Center Jerry H. Hodge School of Pharmacy program. The Grit-Grid, APRS-16, CPSS, and TTMQ were used to measure grit, resilience, perceived stress, and time management skills, respectively, of the student participants.
Grit is defined as perseverance and passion for long-term goals.11 The Short Grit Scale (GRIT-S) is an eight-item assessment in which higher scores have been associated with improved outcomes in undergraduate studies.15 Palisoc and colleagues found no significant correlation in pharmacy students between GRIT-S scores and academic success, but the score did correlate with the pursuit and attainment of postgraduate training.16 Pate and colleagues showed in pharmacy students that higher GRIT-S scores were associated with students who self-reported GPA≥3.5 versus participants who reported a GPA of 3.0-3.49.5 A possible limitation of using the GRIT-S tool is that the score can be easily inflated for high-risk situations such as admission to pharmacy school.11 The APRS-16 scale embeds the GRIT-S scale and was associated with on-time progression.
Another measurement of grit is the ability to sustain extracurricular activities and achieve excellence in them.11 Extracurricular involvement has been correlated with higher GPAs and school engagement among adolescents while in high school.17-19 A 2006 study found participation in school clubs and organized sports in 11th grade was associated with a higher educational status two years later.20 In addition, participation in school clubs and prosocial activities correlated with more social engagement two years later. Recent data indicate that greater involvement in extracurricular activities in high school correlates with the increased likelihood of attaining a bachelor’s degree in college.21 Past participation in sports with higher levels of achievement was associated with less burnout among medical student participants.6 The Grit-Grid is an assessment tool that captures extracurricular involvement and level of achievement. Based on the results of this study, a Grit-Grid score>0.9, which reflects a student’s involvement in at least one extracurricular activity for two or more years during high school, was the strongest nonacademic factor that correlated with on-time progression within the program.
Health professions students, including pharmacy students, report experiencing high levels of stress within their academic programs.7-8,22 Hirsch and colleagues evaluated the CPSS in 145 pharmacy students across all four years of the curriculum.23 The perceived stress was significantly higher among first-, second-, and third-year students compared to prepharmacy students prior to entering pharmacy school. High levels of stress have previously been correlated with negative effects on health, quality of life, and academic performance.8,9,23,24 However, the results of this study found that a CPSS>34, which indicates high stress, was correlated with on-time progression.
When combined with a PPGPA>3.2, a high school Grit-Grid score>0.9, APRS-16>35, and CPSS>34 significantly predicted on-time success. These factors were significantly better predictors than individual or composite PCAT scores and the school’s admission rubric score. Poorer academic performance with a PPGPA≤3.2, a high school Grit-Grid score≤0.9, and APRS-16≤35 also predicted potentially unsuccessful students. This leads us to wonder whether students with increased stress but higher grit (ie, perseverance) progress through the curriculum at a higher rate. Those students who can persevere despite the additional stress are potentially the ones who will be successful.
Several limitations to this project should be considered. There was a low response rate (37.4%), even with financial incentives and multiple reminder emails. The survey was also conducted during the COVID-19 pandemic, during which most of our students were attending classes remotely. The interrater reliability of the high school Grit-Grid was low (Krippendorf alpha statistic=0.448), but it was very consistent for evaluating one activity for two years or longer. The Texas Tech University Health Sciences Center Jerry H. Hodge School of Pharmacy curriculum is an extensive four-year curriculum with 169 semester credit hours in a research-intensive public institution. The results of this study might not extrapolate to other types of universities (eg, private universities and nonresearch public universities).
CONCLUSION
In our study, several nonacademic factors, when combined with PPGPA, were associated with on-time progression. Based on the results of this study, it may be reasonable to implement the Grit-Grid, APRS-16, and the CPSS in the admissions process to help determine the most appropriate candidates for our program. Alternatively, the school could consider using these survey scores as screening tools for incoming first-year students to identify who may be at academic risk. These factors need to be validated in pharmacy programs in other private and public universities before widespread adoption into admissions criteria can be condoned.
- Received October 20, 2021.
- Accepted March 17, 2022.
- © 2023 American Association of Colleges of Pharmacy
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