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Integrating APPE & NAPLEX for Early Prep

An Interview with

Lisa Killam-Worrall, PharmD, BCPS

Assistant Dean for Experiential Education
University of North Texas Health Sciences Center

We've all experienced the disappointment of best-laid plans, goals, and intentions failing to come to fruition. Whether a New Year's resolution, a diet plan, or a professional pursuit, the desire to reach a goal is often not enough to get us over the finish line. Consider the iconic (and not terribly helpful) advice and tagline that Nike used for years: Just Do It. If only life was that simple! Just do it. Most of us have more than just one thing to do, and therein lies the challenge.

We recently had the privilege of interviewing one of our Pharmacy Institutional Partners regarding the challenges and successes her program experiences in helping their P4 pharmacy students finish strong and prepare sufficiently for the NAPLEX. We're sharing some of the secrets they've revealed in hopes that it might help your program and students create a study plan and stay the course.

Lisa Killam-Worrall, PharmD, BCPS is Vice Chair for Experimental Practice and Education at the University of North Texas Health Science Center (UNTHSC). Dr. Killam-Worrall began implementing High-Yield's NAPLEX Review Course with UNTHSC's pharmacy students several years ago. She successfully leads and implements improvements for UNTHSC students. Students are well-prepared for the NAPLEX Exam and have improved their end-of-APPE Rotation Assessments with High-Yield's curriculum. But let's not get ahead of ourselves.  First, let's explore the challenges Dr. Killam-Worrall faces, which are also plaguing so many other universities and students.

What is the Problem?

The NAPLEX Exam is the final hurdle to beginning a pharmacy career. Students work diligently for years gaining necessary knowledge and skills, many of whom incur significant debt or expenses as a result. This final barrier often impedes their ability to begin practicing the profession in which they have invested so much. Surely, this is sufficient motivation for students to determine a study plan, start early, and run the race well, right? Well...it appears not.

Dr. Killam-Worrall explains that many students in her program struggle with time management, especially during rotations. Many students have families, some travel for rotations, and many are simultaneously applying for residencies and jobs. Juggling so many demands naturally lead to delaying NAPLEX preparation until late in the year.


What Didn't Work

Like many programs, the university provided students with NAPLEX preparation tools and resources then encouraged them to Just Do It. And yet, they didn't do it. These are highly performing and motivated students who simply had too many other priorities clambering for their attention. Often, when they finally began preparing with the exam bearing down, the deficits in their knowledge outweighed the time available to review; they didn't know where to start.

A Feasible Solution

Students prepare for future careers as pharmacists during clinical rotations. Students encounter concepts that they learned in the classroom being applied in the clinic; a critical factor in solidifying the learning process. Dr. Killam-Worrall knew that integrating NAPLEX preparation with the APPE rotation experience would produce compound benefits. In collaboration with High-Yield, UNTHSC now requires students to watch lectures and complete practice Q-Bank questions during each rotation as part of their APPE experience. Students are required to complete a set of defined lectures for each rotation with a small percentage of content left to the students' discretion.

In this model, students are required to begin their NAPLEX preparation at the start of their P4 year and to extend it throughout the year. Students also experience benefits on rotation from listening to lectures. They are better prepared to answer questions on rounds and have a deeper understanding of what they encounter on rotation and how it relates to the pharmacology and disease state reviews. As a result, students perform better on the end of APPE rotational assessments. In addition to prescribed lectures, students choose to watch additional lectures to fill in the gaps. Sometimes this means listening to a topic on the way home from clinic for a better understanding of a specific disease state or treatment observed earlier that day. Some students choose lectures that cover disease states they have not witnessed first-hand on the rotation, but that are common for that rotation, and they should have a clear understanding of.

Tweaking the Process

Integrating APPE rotations is the first step toward success. However, Dr. Killam-Worrall listens to her students' feedback and continues to adjust, improving the program.

Q-Bank Questions:

In the first year of implementation, students were required to complete a very large quantity of Q-Bank questions during each rotation. Results varied including a sense of overwhelm, procrastination until the final day of the rotation, and poor performance.

Test question practice is essential to test preparation. Students must sit a 225-question exam, hence the need to apply their knowledge to a multiple-choice question format prior to assessment. The program now requires fewer questions for each rotation and requires a minimum percentage correct to ensure students give the questions full effort. Students are strongly motivated to complete questions weekly to avoid procrastinating. This approach improves student performance and satisfaction. Most importantly, it maximizes student benefits. High-Yield's question bank offers comprehensive answer rationales alongside core concepts to enhance learning while allowing for improvements.

Lectures for P3 Students:

P3 students now receive specific lecture content assignments for reviewing content from the previous year. Early integration provides students with a firm foundation to begin rotations confidently. Also, engaging with lectures prior to rotations makes ongoing integration a positive experience because students appreciate its value.


Identifying Strengths and Weaknesses

High-Yield NAPLEX Review material integration leads students to proactively prepare for the NAPLEX Exam while enriching their APPE Rotations. In addition to integration, two additional tools equip students to prepare efficiently and effectively: live Q-Bank performance data and NAPLEX practice exams.

Although students are not assigned specific question areas for each rotation, they are encouraged to answer questions across all categories. Some NAPLEX curriculums provide specific quizzes or sets of questions that can cause students to fixate on achieving a required score, and often result in cheating.

When students randomly choose questions from a 3,000+ question bank, they receive a variety of question types, formats, and difficulty levels. They also have access to a living "My Performance" tool showing performance statistics in each category. Students use this feedback to choose lectures that will shore up areas of weakness. Students can then customize study plans based on their individual needs using personal performance data.

P4 students take a NAPLEX practice exam midyear annually to gauge their NAPLEX readiness. Faculty receive reports showing collective and individual student performance. This data guides the administration and faculty to make needed adjustments in the program or curriculum, as well as to identify individual students needing additional intervention. Students receive individualized reports and structure their studies based on areas of weakness. Prior to graduation and exams, students take a full-length practice test for final assessment and feedback.

Keep Learning Fun

Founder Anthony Busti, MD, PharmD, MSc, FAHA, often says: "Keep learning fun, evidence-based, and clinically relevant." Students who start early build confidence so that when they enter the clinical environment, it's fun. They apply their knowledge while studying simultaneously and it starts to come together. This is also known as learning transfer which equips students with true understanding instead of memorized facts. Students learn the content through their courses and lectures, practice it with Q-Bank questions, and apply it in clinical scenarios. This results in students being prepared for success on board exams and in practice.


Want to see the interview? You can view it here:


Are you a faculty member interested in learning more about High-Yield NAPLEX Review materials? Learn more here.

Are you a student ready to begin your prep? Get started early and excel in APPE rotations and on the NAPLEX Exam! Check out our courses here.

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