Use of cumulative examinations at U.S. schools of pharmacy

American Journal of Pharmaceutical Education,  Winter 2000  by Ryan, Gina J,  Nykamp, Diane

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A questionnaire was mailed to the department of pharmacy chairs at 77 schools of pharmacy to investigate the current use of cumulative examinations at schools of pharmacy. Information collected included: demographics of the pharmacy school, usual examination format and whether the school administered cumulative examinations. Schools that administered cumulative examinations were also questioned regarding the format, test content, advantages/disadvantages of administering this examination and consequences resulting from examination failure. Forty-six (59.7 percent) completed questionnaires were returned. Thirty-seven (80.4 percent) of the respondents did not administer cumulative examinations. Five out of the 37 schools that do not administer a cumulative examination stated they were in the process of implementing a cumulative exam. Nine (19.6 percent) reported administering a cumulative examination. The primary rationale for administering cumulative examinations was to encourage students to review material prior to advancement. Cumulative examinations are rarely used to determine advancement.

INTRODUCTION

Cumulative examinations are comprehensive tests that assess students' knowledge of information from several didactic courses. Cumulative examinations could be used to determine a student's advancement to the next level in a curriculum. The results of these examinations may also be useful for assessment of individual students and/or the curriculum. A cumulative examination differs from the NAPLEX because it is taken prior to graduation during professional training. Cumulative examinations have also been used to help predict the performance of health professional students in clinical experiences(1-4).

Some medical schools use the medical licensing boards for a cumulative examination. The National Board of Medical Examiners (NBME) examination is divided into three parts. Part I assesses whether the examinee can apply the knowledge of key concepts of basic sciences and is usually taken at the end of the second year of medical school. Part II of NBME examinations assesses understanding of the clinical science considered necessary for providing supervised patient care and Part III of the NBME examination assess understanding of the clinical science considered necessary for providing unsupervised patient care. Many medical schools require students to pass Part I of the NBME examination prior to initiating clinical experiences, thus making this examination a cumulative advancement test at their institution(5). Part I of the NBME examination has also been used, in conjunction with other methods, to evaluate a medical school's curriculum(6).

Anecdotal reports suggest that some pharmacy students have difficulty during their experiential coursework because of deficits in basic and applied science knowledge. The best predictor of future academic performance is previous academic performance(7). Performance in a clinical setting appears to be a complex combination of knowledge, attitude and skills. Simon et al studied the personalities of 110 pharmacy students using the California Psychological Inventory and the MyersBriggs Type Indicator to determine if there was a correlation between personality traits and clinical performance. The investigators tested 18 different personality traits and failed to detect a strong correlation between any one trait and performance in a clinical setting. In this study the best predictor of clinical grade point average was pre-clinical grade point average (r=0.66) (8). Fassett et al.(4) developed a cumulative examination that was administered prior to the experiential component of the pharmacy curriculum at one school of pharmacy. The Basic Pharmaceutical Sciences Exam (BPSE) is the examination that was used in this study. BPSE was developed to assess students' knowledge of pre-clinical course work. BPSE covers the following areas: pharmacology, toxicology, pharmaceutics and medicinal chemistry. There was no description of a item validation process of the BPSE. There was no correlation between the BPSE scores and the preceptor evaluations from the experiential coursework. The authors also investigated the effect of remediation on performance. During the same study, half of the students who performed poorly were given remediation prior to starting experiential coursework and the other half of the poor performers served as the control group. There was also no significant difference between the poor performers who received remediation and those that did not.

At another pharmacy school, Gehres et al.(2) studied the relationship between scores on a cumulative examination and clinical performance. The examination was prepared by faculty and included questions regarding basic science, pharmaceutical science, applied therapeutics, math, pharmacokinetics, law and pharmacy administration. The test items were designed to assess higher levels of Bloom's taxonomy and the students' knowledge of didactic material necessary for experimental course work. The questions were case based and required multiple step problem solving skills in order to select the correct response. The authors acknowledged that the examination was incapable of assessing all the skills necessary for performance in a clinical setting. There was no description of the validation process for the examination items. Similar to the Fassett study, students were given a cumulative examination prior to starting the experiential component of the curriculum. There was a weak correlation (r=0.375) between the test scores and performance in a clinical setting. For students who performed poorly on the examination, remediation also had no effect on clinical performance. The purpose of this project was to determine if other schools have experience with cumulative examinations prior to implementing such a policy at our institution. No hypotheses were tested.