US Pharm. 2009;34(Student suppl):9-11.
Currently, there are two tests that are critical to pharmacy students' careers. The first is the Pharmacy College Admission Test (PCAT), which is taken before pharmacy school; the second, the North American Pharmacist Licensure Examination (NAPLEX), is taken after pharmacy school. To better prepare students for these tests, this article will discuss why these tests are administered, the tests' characteristics (e.g., time allotted, number of questions), what material they cover, and what is considered a passing score.
About the PCAT
Students who are thinking about entering pharmacy school have probably already heard of the PCAT.1 The PCAT is endorsed by the American Association of Colleges of Pharmacy, which considers the test to be the best determinant of an individual's qualifications for entering and succeeding in pharmacy school.2 Currently, about two-thirds of U.S. pharmacy schools require the PCAT for admission. The test is developed and adjusted from year to year to ensure accurate prediction of success in the science-based curriculum of pharmacy school. Although the PCAT is viewed by many schools as an important criterion for admission, other factors are considered as well, such as overall undergraduate grade point average (GPA), undergraduate science and math GPA, and extracurricular activities. The PCAT is administered on a few specific dates throughout the year in the United States, and application must be made by a specific date, about six weeks before the test. The exam fee ranges from $105 to $294, depending on method and time of registration and special requests such as hand-grading or alternative testing location.
Format: The PCAT consists of 240 questions and two writing topics.2 The questions are multiple choice, each with four possible answers. The candidate is allowed four hours (which includes a short break) to complete the test. The test is divided into separate sections, each of which is timed separately. During the timed section, students are permitted to work only on the current section. One is not allowed to go back and finish another section; likewise, if one finishes early, it is not permitted to start the next section early. The test is administered in paper format, with the answers marked in pencil on a separate sheet.
The PCAT is divided into seven different sections that are administered in this order: Writing I, Verbal Ability, Biology, Chemistry, Writing II, Reading Comprehension, and Quantitative Ability.1 The test material is meant to be given at an undergraduate level. The Writing I and Writing II sections each must be completed in 30 minutes and are judged on problem-solving ability and effective use of language. The Verbal Ability section assesses nonscientific vocabulary and usage in 48 questions, 60% of them covering analogies and the other 40% involving sentence completion. Thirty minutes are allotted for this section. In the Biology section, students have 30 minutes to complete 48 questions. General biology accounts for most of the questions, with microbiology and anatomy/physiology accounting for the rest. The Chemistry section also comprises 48 questions to be answered in 30 minutes, 60% them on general chemistry and the other 40% covering organic chemistry. The Reading Comprehension section is designed to evaluate the student's ability to understand and analyze scientific passages. This section contains 48 questions on six different reading passages and must be completed within 50 minutes. In the Quantitative Ability section, students are evaluated on mathematical skills and quantitative reasoning in the subjects of basic math, algebra, probability, statistics, precalculus, and calculus. This section consists of 48 questions, and 40 minutes are allowed for completion.
Some questions in each section are experimental, which means that they are used to develop future versions of the exam and do not contribute toward the final score. Experimental questions are indistinguishable from the other exam questions.
Test Score: There is no "passing" score for the PCAT, but pharmacy schools require a certain minimum score for a student to apply for admittance, with possibly an even higher score being necessary in order to be considered for acceptance.1 This minimum score varies by institution. Students should familiarize themselves with the scores their schools of choice require for acceptance. In general, the higher one's PCAT score, the better one's chance of admission to a respected and competitive pharmacy program.
A few weeks after completing the PCAT, the examinee will receive a scaled score and a percentile for each of the five multiple-choice sections, and a composite score for those five sections. The scaled score runs from 200 to 600 and the percentile score ranges from 1 to 100. The scores do not give a percentage, but rather compare one's percentage to those of the other students who completed the exam at the same time of year. If one is dissatisfied with the score, it is permitted to retake the PCAT as many times as desired. How multiple exam scores are considered depends on the institution being applied to. Some schools look at only the highest grade, whereas others may take the average of all or some attempts.
As a fourth-year PharmD candidate, I took the PCAT three times, and each time my score improved dramatically. Since the test is so well standardized, the sections I did well in the first time remained highest on all three tests. As I studied more and more diligently for the other sections, those scores improved successively.
About the NAPLEX
The NAPLEX is not only one of the last exams a pharmacy student takes, it is also the most important exam. It was developed by the National Association of Boards of Pharmacy to ensure that graduating pharmacy students are both competent and sufficiently knowledgeable to obtain a PharmD license and practice pharmacy. One may take the NAPLEX after graduating from an accredited school of pharmacy. The test may be taken yearly, Monday through Saturday (excluding holidays), through Prometric testing centers. Depending on one's school, however, the student or the college must contact the board of pharmacy of the state in which licensure is desired to obtain the proper paperwork to apply for the exam. The base fee for taking the NAPLEX is $325; there are additional vendor administration fees, which vary by state.
Format: The NAPLEX consists of 185 questions.3 The exam format is multiple-choice questions with a choice of five answers. The answers are either five single-choice answers or five multiple-answer responses. Four hours and 15 minutes are allowed to complete the exam, with a short break halfway through. Many of the exam questions are case-based, meaning that the examinee must read a specific case before selecting the most appropriate answer. The exam is designed such that if there are multiple questions regarding one case, the answers are independent of each other--it is not necessary to get the first one right in order to correctly answer the other questions. The exam also has stand-alone questions that do not require the reading of a case. Since the NAPLEX is a computer-based examination, the examinee cannot skip or omit answers or go back and change an answer once it has been confirmed. This exam is unique because it is adaptive: It modifies the difficulty of the examinee's questions based on the correctness of the response to the previous question.
The NAPLEX is divided into three sections that test the PharmD candidate's ability to, respectively, assure safe and effective pharmacotherapy and optimize therapeutic outcomes; assure safe and accurate preparation and dispensing of medications; and provide health care information and promote public health.4 The sections are designed to ascertain whether the examinee demonstrates the knowledge, judgment, and skills requisite for entry-level pharmacists. Assessment of proper pharmacotherapy and outcome optimization constitutes 54% of the exam. In this section, the successful examinee is able to triage a patient, identify appropriateness of therapy, and manage regimens in a manner that shows good communication between the patient, the pharmacist, and other health care workers.
The section that evaluates the preparation and dispensing of medications comprises 35% of the exam.4 In this section, one is expected to perform calculations required to compound, dispense, and administer medications. The examinee also is evaluated on selecting, dispensing, and preparing medications in safe and effective ways. One's ability to prepare and compound extemporaneous and sterile products is determined by this section.
Accessing, evaluating, and applying information to promote optimal health and educating the public about medical conditions, wellness, supplements, and devices are evaluated in the final section, which accounts for 11% of the exam.
Test Score: The minimum accepted passing score is 75.3 This score is not a percentage; it is determined by assessing the candidate's ability level on the NAPLEX and comparing this with the predetermined minimum acceptable ability level. It is estimated that, to earn a score of 75, one must answer approximately 60% of the questions correctly. To receive a score, one must complete at least 162 questions. If one completes at least 162 questions but less than the entire exam, a penalty is applied to the score. An examinee's NAPLEX score is reported to the state board of pharmacy from which one desires licensure approximately five days after the exam. The state board of pharmacy will then report the score to the examinee. A test-taker who does not pass the NAPLEX will receive a personal performance profile that will assist in identifying their strengths and weaknesses. In the event of a failing score, one must wait 91 days before taking the exam over. Like the PCAT, the NAPLEX has experimental questions. Thirty-five of the questions on any given NAPLEX are experimental.
Predictors of NAPLEX Success: In 2007, Texas Tech University Health Sciences Center School of Pharmacy conducted a study to determine which preadmission variables were positively correlated with NAPLEX success.5 The results showed a relationship between PCAT and NAPLEX scores. Texas Tech University used variables similar to those used by colleges of pharmacy to determine an applicant's acceptance into pharmacy school. Some of these variables were:
* GPA calculated only from required preprofessional courses
* Whether organic chemistry was taken at a two-year or four-year institution
* Any chemistry, biology, or math courses beyond required prerequisites
* Attaining a BS, BA, or MS degree prior to admission
* PCAT scores
* Age upon admission.
A full review of the data was conducted to determine the strongest predictors of success on the NAPLEX (measured by a passing score of 75 on a scale of 0 to 150).5 Of the aforementioned variables, composite PCAT scores and prepharmacy GPA were positively correlated with NAPLEX scores in 373 PharmD graduates. The breakdown from the PCAT analysis revealed that Quantitative Ability, Reading Comprehension, Verbal Ability, Biology, Chemistry, and composite scores, respectively, had increasing correlation with NAPLEX success. There was an inverse relationship between age and NAPLEX score in one analysis.
Why do pharmacy schools conduct studies like this one? When PharmD graduates do well on the NAPLEX, it generally reflects positively on their school's national rating. When considering applicants for pharmacy school, colleges of pharmacy benefit from selecting students with the highest potential to successfully pass the NAPLEX. Data from this study give schools some variables that show a correlation with NAPLEX success.
REFERENCES
1. PCAT Prep Info. Helping you prepare for taking the PCAT. http://pcatprepinfo.com. Accessed January 7, 2009.
2. Brigham Young University. Pharmacy College Admission Test (PCAT) info. http://ccc.byu.edu/healthpro/
3. ProntoPass Solutions. Taking the NAPLEX. www.prontopass.com/links_more_
4. NAPLEX Blueprint. The NAPLEX competency statements. www.nabp.net/ftpfiles/NABP01/
5. McCall KL, MacLaughlin EJ, Fike DS, Ruiz B. Preadmission predictors of PharmD graduates' performance on the NAPLEX. Am J Pharm Educ. 2007;71:5.
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