The North American Pharmacy Licensure Examination (NAPLEX) has always been a high-stakes exam; however, the stakes of passing the naplex got even higher over the last few years. How did we get where we are now?
While pharmacy academia prepared a pharmacy workforce capable to provide pharmaceutical care to retiring baby-boomers, three unforeseen job market drivers raised from behind the scenes endangering a pharmacist’s ability to secure a full-time job.
Under the urge of paying off their mortgages, aging pharmacists postponed their retirement. This age-group decision prevented new grads’ hiring in the originally forecasted counts, as initially expected.
Moreover, drug-dispensing robots’ use expanded far beyond the pharmacies’ doors, entering the small medical practice arena. Furthermore, hospitals tripled or quadrupled the number of mid-level practitioners, such as physician assistants and registered nurses, while they barely added 1 or 2 pharmacist positions to their pharmacy services. Last, not least, now Amazon is getting in the pharmacy business and they surely don’t plan to have the drugs filled by too many pharmacists either!
You can not afford to take too much time just to study for NAPLEX.
Why am I even mentioning all these to you? Because, as soon as you graduate from pharmacy school, you will be competing with all of the above and then some! You can not afford to take too much time just to study for NAPLEX.
You cannot delay securing a job. It must happen as soon as possible, ideally even before you graduate, and for this – Dear Pharmacy Student – you need a very solid plan for how to pass the NAPLEX as soon as possible after the ink dried on you PharmD diploma.
By now you most likely heard more than once that pharmacy is a very versatile profession and that the sky is the limit. That is true. However, that solely depends on your ability to adapt to change quickly and includes your plan for when and how you study for NAPLEX.
Preparing for and passing the NAPLEX will be one of the most important investments you will make in your lifetime. Think of it the same way you think of your future 401k, except for the fact that there will be no matched contribution compounding under your name. So, the sooner you start contributing toward your NAPLEX preparation, the more you will allow your chances to grow.
Aim to see 1000 patient cases before you graduate
NAPLEX preparation should begin the first day of school, but more often than not joggling new responsibilities and passing exams take priority over NAPLEX preparation. That is a pity. Patient care should be top responsibility starting day 1.
I have coached and trained countless pre-pharmacy and pharmacy students one-on-one. A vast majority of them are clinical pharmacy managers or pharmacy specialists today. All passed NAPLEX within a few months after graduation.
There is another common feature my students had: they all stepped in the clinic as soon as they joined my team and this has been KEY for the successful passing of the NAPLEX.
The board examination is designed with the patient in mind, not with the average GPA that one graduates with. Even a GPA of 4 may do you no good if you only seen a few patient cases. Ideally, one needs 800 to 1000 successfully handled patient cases to be prepared for the NAPLEX and clinical practice. How do you get to that performance?
Do these five things to experience more patient cases
Step 1. Check out the NAPLEX passing rate for your school. That should give you a fair estimate of how well the graduates were prepared before they graduated. Yet, remember that one gets what (s)he puts in and do take full responsibility of what you want to do and what you wish to became.
Step 2. Find out how many advanced in-patient experiential rotations are required by your school during your fourth year. While ACPE and most schools require one advanced in-patient experiential rotation, the best pharmacy programs in the country hold their students up to three, four or even 5 in-patient experiential rotations.
Students, generally, hate having to go through more than one because they are genuinely difficult and led by hard-core, very demanding faculty. The overall impression is that such rotations finalize with lower grades and frustrated students. Nothing could be further from the truth! Don’t buy this!
In fact, these are the learning experiences that will give you the confidence and the skill set you need to pass the NAPLEX. The sooner you go for them, the faster you will be ready for NAPLEX! Talk with your colleagues going through these rotations and identify all the options where you could go.
This is like Navy training: the more difficult the experiences you have, the more prepared you will be to handle anything that comes your way.
Step 3. Get involved with the clinical sites for experiential opportunities as soon as you identify them. Second year in the pharmacy school is a good time to begin. Volunteer-volunteer-volunteer!
You do not need to be on a graded, school-organized rotation in order for you to learn in-patient care. Go and get involved in any way you can. Volunteering in the emergency room at patient triage point will teach you each and every symptom that a patient with a certain given emergency may show-up with. This is prime time learning!
History-taking while helping out nurses will familiarize you with various treatments and disease conditions, will highlight unusual instances that will otherwise require hundreds of book pages to read. Take more responsibility as soon as you get good at one task. The goal is to exceed 1000 patients seen by the time you graduate.
Step 4. Keep in close touch with all the professionals that ever trained you and do reach out with questions and clarifications whenever needed. Don’t be shy and don’t assume anything. Regardless of lacking the available time, deep in their heart, they will love teaching you and they will take the time. It is having the right answers to your questions that will help you score high on your NAPLEX.
Step 5. Dare to approach difficult situations. I wasn’t yet in the PharmD program when I performed the first CPR. It was my first week on this side of the Atlantic and I was still jet lagged.
It seemed like a happy afternoon by the neighborhood’s swimming pool when a recently moved-in guy jumped in and didn’t resurface. My new friends noticed him on the bottom and I remember saying: “If you can take him out, I know what to do”.
I learned how to perform CPR since my second grade and had refreshers every other year thereafter until I graduated high school. Except for the fact that several years passed after my last refresher, it was clear to me that I was the only one there able to do something about it and I did.
There was water everywhere and an unbearable silence despite the two dozens of people gathered around. My patient was easily twice my size. Worst of all, I had no one to back me up for chest compressions. The ambulance only made it after 15 minutes or so. Looking back, I can still say that I was his only chance to live pass that day.
More important than that, though, he was the only chance I had to build the confidence to sign-up for no less than seven in-patient experiential rotations during my PharmD program. It was these rotations that prepared me to fly through the NAPLEX.
This is how I train my students and this is how all my colleagues teaching in-patient care train their students too. Great professionals take responsibility. They fight their weaknesses to get better.
These are not habits that begin after you get the job. This is how you grow; it is a state of mind. Should sickness strike or the situation occur one day, it is this kind of professional that each of us wishes for, isn’t it? Cultivate this mindset as you go through pharmacy school and the NAPLEX will be no match for you.
Work out 25 cases per NAPLEX competency
If you reviewed the NAPLEX Competency Statements published in the most recent NAPLEX-MPJE Bulletin, you probably noticed that there are two areas of competency with a combined total of about 50 specific knowledge items that a pharmacist should master in order to pass the board examination.
Accounting for both these items and the ideally 1000 patient cases worked out before graduation, then we can estimate a rough average of 20 cases per competency identified on that list. For better accuracy, since area 1 of competencies is expected to be addressed in two thirds of the board exam and area 2 in only one third, one may come up with a more effective plan: work out 25 cases per each competency in the area 1 and maybe 15 cases for each of those in area 2.
I know that the above may have surprised you especially if you were ever told that a pharmacy student should strive to see one case for each disease condition they learn about. That should be rephrased as “at least one case for…” and that is still thoroughly insufficient. How is such even possible? It’s actually more possible than one would imagine.
I covered the leukemia outpatient clinic for years. We never had less than 25 patients each day. The chemotherapy infusion clinic had a daily average of 100 patients a day, 300 days a year. Each of these cases had a minimum of 2 other comorbidities in addition to their cancer diagnosis.
We had pharmacy students on site continuously and their cases were always logged together with their notes and interventions. I saved each and every one of them in a designated locked area. When the time came for proper disposal, there was a ton of pharmacy student records marked by a very special history. No, not a figure of speech: that was 2,000 pounds. I looked at the several loaded HIPAA bins leaving for disposal and then I turned and looked at my LinkedIn profile where I was still in touch with the students that once put in that time and effort.
That was one of the most prestigious networks of pharmacy professionals one could hope for. Not even a single one of them ever worried about passing NAPLEX.
You may think that not all clinical sites are as big. Hold that thought for a moment and remember that we now have both electronic medical records and paper archives. Golden clinical information waiting to be (re)discovered and evaluated is there exactly for enthusiastic pharmacy students like you. Wish for it and go for it!
I am willing to bet that your faculty will be thrilled to support you on that quest. I did it for my students and many like me did it as well for their students. I had a student that did not care to see the day light for two experiential rotations and many weekends after her rotations with me ended. She was locked in the basement archives reviewing paper medical charts for one of the most important research projects we had ongoing: a total of 1500 charts holding a few hundred pages each.
The day she finished the chart review she was an expert in diabetes, cholesterol, hypertension, and breast cancer treatment – all at once. She could recite all the possible symptoms, approaches, risks taken that paid off or not, and – most important of all – she could give you a range of probabilities for something happening or not. She passed glowingly through all the following experiential rotations and after she graduated it wasn’t “her” that sat for the NAPLEX, it was a living encyclopedia…
I’d say to you: dare to go beyond the pharmacy curriculum, care to genuinely help people and you won’t even notice when you’re done studying for the board exam!