EDUS660: Research Paper

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A Comparison of Pharmacy Students’ Hospital Pharmacy Experience and Performance on
Errors and Omissions Testing
Laura Morgan, PharmD, BCPS
EDUS 660: Research Methods in Education
Dr. Donna Jovanovich
July 30, 2010
A Comparison of Pharmacy Students’ Hospital Pharmacy Experience and Performance on
Errors and Omissions Testing
In developing the skills needed for the practicing pharmacist, pharmacy students are
expected to accurately and efficiently identify errors and omissions on prescription orders to
verify them for appropriateness and completeness. In PHAR535: Foundations of Pharmacy
Practice IV students are tested on identifying errors and omissions in prepared sterile products.
These assessments are referred to as E&Os. The majority of pharmacy students who enter VCU
School of Pharmacy have no hospital pharmacy practice experience and, therefore, have not been
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Comparison of Pharmacy Students’ Experience and Test Performance
exposed to preparing or reviewing sterile products. Students who lack experience working in a
pharmacy frequently cite this as a reason for poor performance on skills in the classroom.
Research has been conducted to determine if there is a relationship between student
characteristics and success in Doctor of Pharmacy programs. These studies have aimed to
determine which characteristics are associated with completion of the degree program and
achievement of a pharmacist license. Several studies have examined various student
characteristics potentially related to academic performance in schools of pharmacy including
prior completion of a 4-year degree, pre-pharmacy grade point average (GPA), pre-pharmacy
math/science grade point average, pharmacy college admission test scores (PCAT), and age.
Evidence suggests the strongest predictors of first-year pharmacy GPA were pre-pharmacy
math/science GPA and completion of a 4-year degree (Chisholm, Cobb, & Kotzan, 1995). PCAT
scores have consistently demonstrated a relationship with academic performance in pharmacy
school. Other research has suggested a strong relationship between overall pre-pharmacy GPA,
GPA for required pre-pharmacy courses, and PCAT scores and first-year pharmacy GPA. Scores
on PCAT and California Critical Thinking Skills Test (CCTST) were associated with successful
performance in practice-based courses and APPEs (Allen & Bond, 2001). This study aims to
determine whether there is a relationship between hospital pharmacy work experience and
performance on errors and omissions testing, within a single course, PHAR535. The results of
this study will be used to inform the course coordinator of the need to adjust teaching methods
for those students without hospital pharmacy experience.
Review of the Literature
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Comparison of Pharmacy Students’ Experience and Test Performance
Academic performance while in pharmacy school is important for completing the
program but in order to practice as a pharmacist one must pass the North American Pharmacist
Licensure Examination (NAPLEX) test. An evaluation of variables which predict graduate
performance on the NAPLEX was conducted in over 400 students at Texas Tech University
Health Sciences Center Doctor of Pharmacy program. Researchers found a positive correlation
between GPA, PCAT, and CCTST scores. However, the reported coefficient of determination
was only 0.211 which means only 21% of the variance in NAPLEX performance is explained by
these three factors (McCall, McLaughlin, Fike, & Ruiz, 2007). Based on this research, other
factors should continue to be considered in the review process of pharmacy student applicants.
Pharmacy educator researchers have tried to identify the most important factors which
may be related to academic performance of pharmacy students. Many of these studies have
focused on success early in the pharmacy curriculum. However, competency as a practitioner is
the ultimate goal of pharmacy training. Kidd & Latif (2003) conducted a blinded retrospective
record review of three class years of Doctor of Pharmacy students evaluating both traditional and
novel traits of students to determine if they were related to classroom and clerkship success.
Their findings demonstrated a relationship between overall pharmacy GPA and PCAT score,
essay, CCTST, and California Critical Thinking Disposition Inventory (CCTDI). The CCTST
was the only variable which showed a significant relationship to students’ clinical performance
on APPEs. Selection bias was evaluated by comparing the students group for which complete
records were available to those with incomplete records. No statistical significance was found.
Limitations to this study include the lack of consistency in the assessment tool used to evaluate
clinical performance and generalizability to other pharmacy schools.
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Comparison of Pharmacy Students’ Experience and Test Performance
Predictors of academic success are not necessarily predictors of failure. Houglam,
Aparasu, & Delfinis (2005) conducted a study to determine which admissions criteria were
significant predictors of success or failure in a professional pharmacy program. Their findings
showed that ACT composite score, average grade in organic chemistry courses and gender were
associated with failure as defined by academic probation. Predictors of academic success
represented by first-year GPA also included prior attainment of a bachelor’s degree and grades in
math and science pre-pharmacy courses. Data included in the study represented 92.5% of the
student population. However, the regression model that was used explained <50% of the
variation in the dependent measure of academic success. The authors suggest including other
variables such as communication skills, motivation, and critical thinking skills in future research
of this area.
There is one published study which relates students’ pharmacy-related work experience
to performance in the professional pharmacy program. Mar et al. (2010) describe a study of
students’ previous pharmacy-related work experience and pharmacy school performance. A
survey of pharmacy-related work experience was conducted prior to pharmacy school
enrollment. Student focus groups were conducted to review the survey instrument prior to
dissemination. Measures of academic and clinical performance included pharmacy grade point
average, scores on cumulative high-stakes examinations, and grades in advanced pharmacy
practice experiences (APPEs). No significant difference in academic or clinical performance was
found between those students with prior pharmacy experience and those without. A total of 206
surveys were complete and able to be used for analysis. This represents 60.1% of the total
eligible population. Academic measures of the respondents were compared to those of nonrespondents and no statistically significant difference was found indicating no sampling bias.
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Comparison of Pharmacy Students’ Experience and Test Performance
There was a limited number of students (36.9%) who had completed APPEs which makes it
difficult to assess the impact on clinical performance. Less than 10% of the total sample did not
have work experience which may have made detecting differences between the groups more
difficult. Survey response rate was good but did not meet the 70% which is generally considered
adequate (McMillan, 2008). Generalizability is limited considering only one school of pharmacy
was included.
Specific research question
Students who have worked in hospital pharmacy practice and been exposed to sterile
preparation orders are more likely to perform better when tested on these types of formulations
in the classroom. This study will compare errors and omissions test performance of students with
hospital pharmacy experience to those without hospital pharmacy experience and examine the
following hypothesis:
Hypothesis: Students with hospital pharmacy experience will have higher scores on
sterile preparation errors and omissions tests than students with no hospital pharmacy
experience.
Methodology
Design
Using a non-experimental quantitative research design, this study will describe students’
hospital pharmacy experience and compare errors and omissions test performance with students’
hospital pharmacy experience. A comparative design will be used to examine the independent
variable, student hospital pharmacy work experience, with the dependent variable of grades on
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Comparison of Pharmacy Students’ Experience and Test Performance
errors and omissions testing. A convenience sample of all pharmacy students enrolled in
PHAR535: Foundations of Pharmacy Practice IV in Spring 2010 will be included in the study.
There are 120 students enrolled in the course. The population is predominately female (68%) and
Caucasian (56%) with an average age of 26 years. Over 90% of students have completed a prior
4-year degree.
Instrument
The data collection instrument was developed by the course coordinator and consists of
two questions each with five response options. Students used an audience response system to
respond to items indicating the type and duration of any hospital pharmacy work experience.
There was no incentive for students to complete the survey. The instrument has not been piloted
which may affect its validity and reliability. The questions may have been ambiguous or poorly
phrased. Also, the information is self-reported which may lead to lack of credibility of the
responses. Students were not aware that the data was being collected for research purposes. The
risk of embarrassment in front of classmates was reduced by the anonymous method of the
survey. However, the individual responses were known to the course coordinator which could
potentially influence the students’ responses.
Procedures
During the first class meeting of the Spring 2010 semester, data was collected on
students’ prior hospital pharmacy work experience. Demographic data and frequencies of
responses to questions will be reported. During the PHAR535 course, students were administered
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Comparison of Pharmacy Students’ Experience and Test Performance
2 sterile preparation errors and omissions tests and grades were recorded. Test grades for
students with and without hospital pharmacy experience will be compared.
Data Analysis Plan
Descriptive statistics on the characteristics of the study population and their responses
will be reported. A t test will be used to determine if there is a difference in test performance
between students with hospital pharmacy experience and those without hospital pharmacy
experience.
Limitations
The major limitation of this study is the survey instrument. It is not a validated instrument
and may have inherent bias in the wording of questions. Extraneous variables include gaps in
students’ hospital pharmacy experience and unknown variability in the competency of their
pharmacy technician performance. The generalizability of the results of this study are limited
considering only one group of students in one course in one school of pharmacy is being
evaluated. However, considering this is action research, the intention of the study is to use the
results to determine whether a different level of instruction is needed for those students without
hospital pharmacy experience.
References
Allen, D. D., Bond, C. A. (2001). Prepharmacy indicators of success in pharmacy school: grade
point averages, pharmacy college admission test, communication abilities, and critical
thinking skills. Pharmacotherapy, 21, 842-849.
Chisholm, M. A., Cobb III, H. H., & Kotzan, J. A. (1995). Siginificant factors for predicting
academic success of first-year pharmacy students. American Journal of Pharmaceutical
Education, 59, 364-370.
Houglum, J. E., Aparasu, R. R., & Delfinis, T. M. (2005). Predictors of academic success and
failure in a pharmacy professional program. American Journal of Pharmaceutical Education,
69 (3), Article 43.
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Comparison of Pharmacy Students’ Experience and Test Performance
Kidd, R. S., Latif, D. A. (2003). Traditional and novel predictors of classroom and clerkship
success of pharmacy students. American Journal of Pharmaceutical Education, 67 (4),
Article 109.
McCall, K. L., MacLaughlin, E. J., Fike, D. S., Ruiz, B. (2007). Preadmission predictors of
PharmD graduates’ performance on the NAPLEX. American Journal of Pharmaceutical
Education, 71 (1), Article 05.
McMillan, J. H. (2008). Educational research: fundamentals for the consumer. (5th ed.). Boston,
MA: Pearson.
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