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Standardization of Pharmacist Competency: The 2009 National Pharmacy Practice Survey and NAPLEX Standard Setting

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Title: Standardization of Pharmacist Competency: The 2009 National Pharmacy Practice Survey and NAPLEX Standard Setting


1
Standardization ofPharmacist CompetencyThe
2009 NationalPharmacy PracticeSurvey andNAPLEX
Standard Setting
  • NABP President, William T. Winsley, MS, RPh
  • NABP Competency Assessment Senior Manager Maria
    Boyle, MS, RPh

2
North American Pharmacist Licensure Examination
(NAPLEX)
  • Purpose
  • To assess a candidates competence, knowledge,
    skills, and abilities to practice pharmacy

3
Licensing Examinations
  • Measure skills directly related to the purpose of
    licensing (protection of the public)
  • Content domain should be clearly defined and
    justified in terms of its importance in a given
    profession
  • A survey of practitioners provides the basis for
    defining the balance of content within an
    examination
  • Serves as one criteria to make decisions
    regarding professional practice
  • Professional test developers follow standardized
    practices to ensure that tests measure what they
    purport to measure

4
2009NABP National PharmacyPractice Survey
5
Methodology
  • Suggested updates to the competency statements
    are reviewed by the NABP Advisory Committee on
    Examinations and the Executive Committee
  • Once the updated competency statements are
    approved, they are used to construct a practice
    analysis survey
  • In the 2009 update, recommended changes included
    the addition of pharmacoeconomics to three
    competency statements as it relates to clinical
    care and pharmaceutical outcomes
  • The survey is piloted among a subpopulation of
    pharmacists before being launched as a
    large-scale survey

6
Methodology
  • NAPLEX competency statements are continually
    evaluated by subject matter experts (SMEs)
  • All SMEs are practicing pharmacists and/or
    academicians
  • An advisory committee of SMEs oversees the
    process of the competency statements review and
    the practice analysis
  • SMEs review appropriate literature and provide
    perspectives as incumbents to gather information
    to support the content domain description

7
2009 Sampling Population
  • NABP pharmacist database
  • National Association of Pharmacy Regulatory
    Authorities (NAPRA)
  • Pharmacy Practice faculty
  • APPE Preceptors
  • AACP assisted NABP
  • by identifying a sample of pharmacy practice
    faculty to solicit as academic participants, and
  • by forwarding an invitation to participate to the
    Directors of experiential education at colleges
    of pharmacy to assist in targeting experiential
    preceptors
  • 82.6 of US respondents indicated preceptor
    experience in the last five years

8
Survey
  • Online survey was available from April to
    mid-July 2009
  • Respondents were asked to rate each competency
    statement on two scales Criticality and
    Frequency
  • A five-point rating scale was used 1 (low) to 5
    (high)

9
Survey Rating Scales
Criticality Frequency
1 Not serious (e.g. has no effect) 1 Very rarely (e.g. monthly or less)
2 Minimally serious (e.g. causes inconvenience) 2 Rarely (e.g. weekly)
3 Moderately serious (e.g. hinders therapeutic progress or may endanger public health and safety) 3 Occasionally (e.g. daily)
4 Highly serious (e.g. worsens the patients condition or is likely to endanger public health and safety) 4 Often (e.g. hourly)
5 Critically serious (e.g. is life threatening or will definitely endanger public health and safety) 5 Very often (e.g. many times per hour)
10
Examples of Competency Statements
  • Identify and assess patient information including
    medication, laboratory, and disease state
    histories
  • Identify specific uses and indications for drug
    products and recommend drugs of choice for
    specific diseases or medical conditions
  • See the NAPLEX/MPJE registration bulletin at
    www.nabp.net

11
DemographicsofRespondents
12
  • Total Respondents 2,958
  • United States 2,244
  • Canada 714

13
Year of Licensure
Prior to 1980 20.8
1980 to 1989 21.5
1990 to 1999 23.6
2000 to 2009 34.1
Total 100
14
Professional Degree
  • 34 PharmD
  • 48 BS/BPharm
  • 16 Earned both professional degrees
  • 2 No response
  • 27 Reported completing residency

15
Primary Practice Setting
Academia 263 8.9
Community 1,260 42.6
HMO 50 1.7
Home Health Care 19 0.6
Hospital 1,211 40.9
Mail Service 49 1.7
Other 106 3.6
Total 2,958 100.0
16
Ethnicity and Gender
American Indian/Alaskan Native 0.5
Asian/Pacific Islander 9.1
Black 3.1
Hispanic 2.1
White 77.4
Other 2.4
Missing 5.3
Female 53
Male 43.4
Missing 3.6
17
Analysis
  • Survey data were analyzed to determine measures
    on items and to translate those measures into
    content weights for the test blueprint
  • Proportion of weights based on criticality vs
    frequency were made
  • The NAPLEX Review Committee and the Advisory
    Committee on Examinations reviewed the outcomes
    and made recommendations to the Executive
    Committee

18
NAPLEX Blueprint Changes
  • Area 1 Assess Pharmacotherapy to Assure Safe
    and Effective Therapeutic Outcomes
  • Increased from 54 to 56 of examination (equates
    to three additional items delivered)
  • Competency 1.2 now includes pharmacoeconomic
    factors as they relate to the identification and
    selection of pharmacotherapeutic agents
  • Competency 1.3 now includes the evaluation and
    management of drug regimens to enhance safe,
    effective, and economic patient outcomes

19
NAPLEX Blueprint Changes, cont.
  • Area 2 Assess Safe and Accurate Preparation and
    Dispensing of Medications
  • Decreased from 35 to 33 of examination
  • Area 3 Assess, Recommend, and Provide Health
    Care Information that Promotes Public Health
  • Competency 3.1.2 now includes the evaluation of
    pharmacoeconomic data as it applies to patient
    care

20
Whats New with the NAPLEX?
  • New competency statements and blueprint went into
    effect March 1, 2010
  • A new passing standard was set
  • Variety of item types which include
    selected-response and constructed response test
    items
  • Enforcement of score invalidation in cases
    regarding candidate misconduct

21
NAPLEX Standard Setting
22
Establishing a Cut-Score
  • Critical test development issue, particularly in
    high-stakes, criterion-based testing
  • Legitimacy of the standard setting process is a
    significant component of validity evidence
  • What degree of mastery over the content domain
    (knowledge, skills and abilities) is needed to
    establish competency?

23
Overview
  • Panelists (NAPLEX Review Committee,
    practitioners, academicians, preceptors) were
    recruited for a two day workshop
  • NABP provided training on test development and
    standard setting
  • Practice examples, group discussions, and
    opportunities to make practice ratings were
    provided

24
Standard Setting Session
  • Panelists were asked to conceptualize the
    knowledge, skills, and abilities necessary for
    entry-level practice
  • Key considerations focused on public health and
    safety

25
NAPLEX Standard Setting
  • Rater training
  • Standard setting process
  • Expectations
  • How data will be used
  • Defining a qualified candidate
  • Characteristics of a sufficiently knowledgeable
    yet minimally competent candidate (SKYMC) were
    discussed
  • Item ratings
  • Judges consider, answer, and rate real NAPLEX
    items to make judgments on what a SKYMC candidate
    would get correct

26
NAPLEX Standard Setting
  • Preliminary statistical analysis of all of the
    data collected was performed
  • Feedback and impact data were reported to the
    panelists
  • Rating process was repeated and resulting data
    analyzed
  • Considerations for inter-rater reliability
  • Considerations for subjectivity regarding pass
    rates
  • Discussion of outcomes among judges

27
Policy and Recommendations
  • Ranges of potential cut-scores were computed an
    impact analysis was conducted
  • The NAPLEX Review Committee and the Advisory
    Committee on Examinations analyzed outcomes and
    impact data
  • A recommendation was made to the Executive
    Committee for a final decision

28
  • Program Development

29
The Pharmacist Assessment forRemediation and
Evaluation (PARE)
  • NABP Executive Committee recognized the need for
    an objective assessment to address situations of
    questionable pharmacist competency and
    remediation
  • The purpose of the assessment is to provide a
    multidimensional assessment for the boards of
    pharmacy that can be utilized as a contributory
    factor in making decisions about conditional
    pharmacist practice issues

30
The Pharmacist Assessment forRemediation and
Evaluation (PARE)
  • Intended for experienced practitioners
  • Content domains
  • Clinical pharmacy
  • Medication safety management
  • Professional ethics
  • The same industry standards applied to all NABP
    examination and assessment programs shall be
    implemented
  • Expectation for a 2011 launch

31
Questions?Thank you!
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