Should Taking the PCOA Be a Prerequisite for Clinical Rotations?

NOVEMBER 03, 2017
Michael Berger, wrote “How the PCOA Benefits Pharmacy Students,” outlining the student benefits of the Pharmacy Curriculum Outcomes Assessment (PCOA). The exam is meant to be a way for colleges to assess their curricular success under Accreditation Council for Pharmacy Education Standards 2016. However, the practical implications of the exam could be disastrous for low-performing colleges of pharmacy.

There are at least 4 ways the PCOA could harm a pharmacy school. These are:

1. Reducing residency acceptance rates: In a Rho Chi Post article, a very small study found some correlation between the PCOA scores and North American Pharmacist Licensure Examination (NAPLEX) scores. One concern that PGY1 residency directors cannot address is if their applicant will pass or fail the NAPLEX on the first try. The director can look to historical success for the college, but generalizing an individual from a college is unfair and likely unreliable. However, now residency sites may soon have a predictive tool and a threshold number for which to look. Lower residency acceptance rates make a school unattractive to potential clinically minded applicants.

2. Delaying graduations: It seems clear that some students did not take the PCOA seriously. The policy page at the University of California, San Francisco outlines the penalties for “any student deemed by [National Association of Boards of Pharmacy] not to have put forth an honest effort.” Now, however, with the PCOA not only serving as a benchmark to residencies but also against other colleges, it is as, if not more, important than the NAPLEX. The policy that schools may be adopting soon to prohibit students without high enough scores from entering Advanced Practice Pharmacy Experience (APPE) rotations means that the inability to achieve a threshold score on the PCOA could prevent students from taking the NAPLEX entirely. Imagine the angry parent-dean meetings about a student with passing grades who does not pass an arbitrary PCOA score, delaying graduation. The major potential harm to students is that a few colleges, given a certain threshold compared with a national percentile ranking, will likely have disproportionate numbers of students with lower rankings. This could delay swaths of final professional-year students who cannot continue on time. 
3. Pushing away bad test-takers: Some very good students fear standardized exams, and this anxiety often leads to poor testing performance. There is a button on the PharmCAS directory that allows students to sort by schools that require the (Pharmacy College Admission Test) PCAT and those that do not. Currently, 26 schools of pharmacy do not require the PCAT, which may get a student past the admissions exam, but with the PCOA later in the curriculum, some schools may have admitted a disproportionate number of students who struggle with test anxiety.

4. Inviting pushback from APPE sites: Let’s assume that there are more than 14,000 students on APPE rotations at any given time. This is the number graduating annually from pharmacy schools. The percentile comparisons that the PCOAs offer to individual students could backfire; 1,400 students each year will go into APPE rotations as the bottom 10% nationally. This is a mathematical certainty. Prior to the PCOA, there was no quantitative way to compare students. Now, however, an APPE site could put threshold limits on which they take. Also, an APPE site could ask students for their scores to determine where they stand to adjust their own curriculum. With percentile scores, 7,000 would present scores in the bottom 50%. But, is it fair or safe for a student or the site to have someone in the bottom 10% working in critical-care or high-level clinical rotations?

The PCOA testing window may also set up a nightmare for experiential offices that have placed students, only to find that they are not permitted to continue into those rotations. Although pharmacy schools may self impose thresholds for students to move on to the fourth year, this could also backfire as students may simply drop from pharmacy school altogether, pushing the 11% 5-year attrition rate even higher.

In his article, Dr. Berger wrote that “[t]he PCOA seems to have benefits that extend beyond the purpose of a curriculum assessment, as its results could potentially help pharmacy students secure jobs or residency positions.” The converse is also true; the refusal of a student to disclose his or her PCOA scores would raise a red flag and make for a very uncomfortable fourth professional year.

In my APPE rotation, I wouldn’t want to know a student’s PCOA score at all. I would want to judge them on the work they do, rather than a score they earned. With so much possibly riding on the PCOA, I would turn to for one of their blog posts on studying for it.

Tony Guerra, PharmD
Tony Guerra, PharmD
Tony Guerra, PharmD, is chair, instructor, and pre-pharmacy advisor at Des Moines Area Community College's Pharmacy Technician program and Pharmacy Podcast Network Co-Host. He's Tony_PharmD on Twitter and TonyPharmD on YouTube providing Top 200 drugs and pronunciation help to over 4,500 followers with over 1 million views. His two audiobooks Memorizing Pharmacology: A Relaxed Approach and How to Pronounce Drug Names: A Visual Approach to Preventing Medication Errors are Amazon bestsellers. He graduated from Iowa State University with a BA in English and the University of Maryland with his PharmD.
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