As a recent pharmacy school graduate, I took the National Pharmacy Licensure Exam (NAPLEX) and the Multi-state Pharmacy Jurisprudence Exam (MPJE). A hot topic of conversation among my classmates is the pass rates on these exams. Being a “good” student who earned A’s and B’s throughout pharmacy school, I expected the NAPLEX to be something that I would be able to easily pass — boy, was I wrong! To my, my friends, and my family’s surprise, I received a “FAIL” on my first NAPLEX attempt. The word FAIL staring me in the face that day last June was a major kick in the gut. Since I passed my MPJE shortly after graduation in May, I thought the NAPLEX would be a similar outcome. Luckily, in July, I received a “PASS” on my second NAPLEX attempt.
It was shocking to me, but I was not the only one from my graduating class that had to retake the NAPLEX. How in the world had we made our way through pharmacy school just to receive a big fat “FAIL” when taking our boards? Our school and the professors certainly did everything they could to push us toward success on our boards. We had a year-long NAPLEX prep course that ran concurrently with our advanced pharmacy practice experiences (APPE). We were given various assignments to “ensure” that we were preparing ourselves for these challenging exams. We had multiple practice exams to give us experience. In December of my P4 year, I scored 69 on my first practice NAPLEX. Although this is not a “passing” score, I felt I was on the right track as I was just getting deeper into my studying. In the spring of my P4 year, I took another practice exam and brought my score up to 73. I was improving but I recognized that had more studying to do.
There have been multiple studies published in recent years examining factors that might help students be successful on their board exams. One cross-sectional study sought to describe the characteristics of NAPLEX preparation programs currently offered by schools of pharmacy and the correlation between program characteristics and first-attempt pass rates. Fifty-eight Pharm D programs completed an online survey about their NAPLEX preparation programs. A majority (86%) of schools indicated they offered a NAPLEX prep program. But offering a NAPLEX prep program was not associated with higher first-attempt pass rates. Some concerns raised by the authors of the paper included student workload (e.g., balancing the demands of a prep program during APPEs) and the faculty workload associated with delivering these programs.1
In a retrospective study, investigators compared NAPLEX scores (n=150) to several factors that might predict performance. The investigators found that the NAPLEX score was most strongly correlated with pharmacy GPA (r=0.66) and Pre-NAPLEX score (r=0.45) but also race/ethnicity, Pharmacy College Admission Test (PCAT) composite score and section scores, undergraduate GPA, undergraduate science GPA, and on-time graduation.2
In another retrospective study, the correlation between preparatory testing and other factors were compared to performance on the MPJE. This analysis showed that the Pre-MPJE scores failed to predict whether a student would pass the MPJE but a student’s performance in the pharmacy law course did.3
As you can see from the results of these studies, there is no clear correlation between prep courses and the odds of passing either the NAPLEX or MPJE. Therefore, simply having such courses available does not ensure success. Thus, it is truly up to individuals to ensure that they are using prep courses, practice exams, and other resources to fully prepare themselves. It is difficult to find a quick and easy fix to improving first-time pass rates for board exams. There are many “tips and tricks” on the Internet. These “tips and tricks” seem to be consistent with things students have likely heard during pharmacy school – things like having a study plan, taking practice tests, creating self-testing materials, working with a study group, getting plenty of sleep, and not cramming.
Spaced repetition is a study technique that involves reviewing and recalling information at optimal spacing intervals until that information is deeply learned. This technique has students review materials, repeatedly, over a long period of time. Research has clearly shown that spacing out repeated encounters with material over time provides superior long-term retention. Self-testing coupled with spaced repetition amplifies the benefits.4
As I’ve learned, it’s important to study and prepare for the MPJE and NAPLEX well in advance. I was able to pass my MPJE solely on the material learned during our pharmacy law course and our professor was very clear about how hard and tricky the exam could be. I was able to pass my NAPLEX on the second try by realizing my areas of weakness. I used the same study strategies, but by being more self-aware of my weaknesses I was better prepared for my second attempt. Perhaps the best approach is to help students figure out what they do not know and then encourage them to use effective evidence-based study techniques.
There are several evidence-based learning and studying techniques, like spaced repetition, that can be used to enhance a student’s recall of information, but it is truly up to the student to “take the bull by the horns” and get the studying done. Students need to know very early in their pharmacy school journey just how hard these exams can be.
- Fiano K, Attarabeen O, Augustine J, et al. Association between Naplex Preparation Program Characteristics and First-Time Pass Rates. Am J Pharm Education 2022; 86(6): Article 8760.
- Chisholm-Burns M, Spivey C, Byrd D, McDonough S, Phelps S. Examining the Association between the NAPLEX, Pre-NAPLEX, and Pre- and Post-admission Factors. Am J Pharm Education 2017; 81(5): Article 86.
- Havrda D, Hall E, Spivey C, et al. Examining Preparatory Testing and Other Factors Associated With Performance on the Multistate Pharmacy Jurisprudence Examination. Am J Pharm Education 2022; 86(7): Article 8774.
- Kang S. Spaced Repetition Promotes Efficient and Effective Learning. Policy Insights from the Behavioral and Brain Sciences(PIBBS) 2016; 3 (1): 12-19.