Factors associated with applicant performance on the Saudi Pharmacist Licensure Examination (SPLE)

Abstract

Background

Limited data are available on factors that are associated with passing rates for the Saudi Pharmacist Licensure Examination (SPLE). The aim of this study is to investigate student characteristics and academic performance characteristics that may predict their success on SPLE.

Methods

This was a single-institution retrospective cohort study, which included pharmacy graduates from 2019 to 2021. Demographic, academic, and SPLE data were collected for each graduate. Binary logistic regression was used to explore the association between potential predictors and first-time SPLE pass status. A stepwise regression was then performed to develop multiple logistic models.

Results

A total of 494 graduates were included in the study. Females, PharmD graduates, and on-time graduation had higher odds of passing SPLE (P = 0.0065, P = 0.0003, and P < 0.0001, respectively). For each 0.5 increase in GPA, the odds of passing SPLE increase by 3.5 times (OR 3.53; 95 % CI, 2.83–4.42; P < 0.0001). Of the tests taken prior to university admission, the overall high school score, general aptitude test (GAT) score, and qualifying score were significantly associated with higher SPLE first-time pass rates. When multiple logistic regression analysis was performed, GPA and GAT scores were the only significant predictors for higher SPLE first-time pass rates (P < 0.0001 and P = 0.0002, respectively).

Conclusion

The current research has shown that there is an association between higher SPLE first-time pass rates and several factors, most importantly the GPA and GAT score. Further research is needed, as it has the potential to inform the decision when reviewing pharmacy admission criteria.

1. Introduction

The Saudi Commission for Health Specialties (SCFHS) has adopted rigorous regulations to evaluate and establish standardization in the credentials of healthcare professionals, including medical doctors, nurses, dentists, and pharmacists. One of the regulations implemented by the SCFHS mandates that newly graduated students or health professionals from abroad are required to undergo an examination that evaluates their competency in their specialty and ensures that it meets the minimum level set by the SCFHS (Sales et al., 2022). The Saudi Pharmacist Licensure Examination (SPLE) was introduced in January 2019 by the SCFHS as a requirement for all pharmacy graduates seeking to obtain a pharmacist license, and it was designed to assess the competencies of pharmacy graduates to ensure safe practice.

Limited studies are available in the literature that have looked into the factors that may influence the first-time SPLE passing rate. A single-institution study has found an association between a high SPLE score and other variables such as applicant sex, GPA in pharmacology courses, and grade point average (GPA) in therapeutics courses (Alhifany et al., 2020). Another study that examined the SPLE passing rate of a larger sample size (n = 2284) from different universities demonstrated that gender (female compared to male), exam year (2020 compared to 2019), and colleges established in or before 2006 are significant predictors of a higher SPLE first-time pass rate (Alghamdi et al., 2022). However, it is important to note that the study did not gather comprehensive data on individual candidates, such as their GPA, high school score, and other academic performance criteria. Similar and other factors were investigated in other national exams, such as the North American Pharmacist Licensure Examination (NAPLEX) exam in the United States. Predictors of the NAPLEX first-time pass rate included younger age, higher GPA, and higher Pharmacy College Admissions Test (PCAT) scores, race and ethnicity, and on-time graduation (Chisholm-Burns et al., 2017, McCall et al., 2007).

Therefore, there is a need for further research to overcome the limited data on SPLE and gather more comprehensive data on individual candidates. By conducting studies with larger sample sizes and including a wider range of variables, such as applicant background and performance indicators, a better understanding of the factors affecting success in the SPLE can be achieved, which will ultimately contribute to the development of effective strategies and interventions aimed at improving the SPLE first-time pass rate. The objective of this study is to investigate applicant factors on their performance in SPLE by utilizing a retrospective cohort study design within a single pharmacy institute.

2. Methods

2.1. Data collection

This was a retrospective cohort study, which included pharmacy graduates from King Khalid University during the years of 2019, 2020, and 2021. A data extraction sheet was created that included all variables of interest, including sex, program type [Bachelor of Pharmacy (BPharm) or Doctor of Pharmacy (PharmD)], study duration (in semesters), graduation year, academic information including the GPA (out of 5), as well as data prior to enrolling in the university such as high school overall score (out of 100), general aptitude test (GAT; out of 100), and academic achievement test (AAT; out of 100). GAT and AAT are tests conducted by the National Center of Assessment at the Education and Training Evaluation Commission in Saudi Arabia. The qualifying score was calculated by taking the sum of 30 % of the high school overall score, 30 % of the GAT, and 40 % of the AAT. These data were retrieved from the student record system. SPLE pass status for each graduate was collected from the Saudi Commission for Health Specialties website. The study was approved by the Institutional Review Board at King Khalid University (ECM2022-117).

2.2. Statistical analysis

Continuous variables were summarized as means and standard deviations. For categorical variables, frequencies and percentages were used to describe the data. Binary logistic regression was used to explore the association between potential predictors (sex, program type, on-time graduation, had > 2 internal medicine/acute care rotations, GPA, high school score, AAT score, GAT score, and qualifying score) and first-time SPLE pass status (i.e. passed or failed). A stepwise regression was then performed to develop multiple logistic models using a backward procedure. In the stepwise approach, the p-value was set to 0.05 as the exclusion criteria for individual predictors. Statistical analyses were performed using JMP® Pro v17 (SAS Institute Inc., Cary, NC).

3. Results

3.1. Population demographics

Records of 534 students who graduated in 2019, 2020, and 2021 were retrieved. A total of 494 graduates were included in the study, after excluding 40 graduate records for the unavailability of their SPLE scores. Approximately 51 % of the graduates were male, and around two-thirds graduated during the expected time (Table 1). The average GPA was 3.6 (out of 5), with about 44 % of them obtained a “very good” grade or higher. The mean scores for the overall high school score, AAT score, and GAT score were 97.7 %, 73.7 %, and 79.5 %, respectively. The mean calculated qualifying score was 82.6 %. Of the collected data, about 32 % of the graduates sat for the SPLE for the first time in 2019, 39 % in 2020, and the remaining in 2021. The SPLE overall pass rate was 80 %. The average GPA for graduates who passed SPLE on their first attempt was 3.98 (±0.55), compared to 3.20 (±0.52) for those who failed the exam.

Table 1.

Characteristics of pharmacy students graduated during 2019, 2020, and 2021.

Characteristic	n(%) or mean (SD) n = 494
Sex
Male	251 (50.8)
Female	243 (49.2)
Program
BPharm	310 (62.8)
PharmD	184 (37.3)
Study duration (semesters)
BPharm	16.8 (1.7)
PharmD	18.2 (1.5)
On-time graduation
Yes	339 (68.6)
No	155 (31.4)
Had > 2 internal medicine/acute care rotation
Yes	71 (48.3)
No	76 (51.7)
GPA grade
Excellent	49 (9.9)
Very Good	167 (33.8)
Good	221 (44.7)
Fair	57 (11.5)
GPA	3.6 (±0.7)
High school score	97.7 (±1.9)
AAT score	73.7 (±4.4)
GAT score	79.5 (±5.1)
Qualifying score	82.6 (±2.6)
First-time SPLE year
2019	157 (31.8)
2020	192 (38.9)
2021	145 (29.4)
SPLE status
Pass	395 (80.0)
Fail	99 (20.0)

AAT: Academic Achievement Test; BPharm: Bachelor of Pharmacy degree; CI: confidence interval; GAT: General Aptitude Test; GPA: grade point average; PharmD: Doctor of Pharmacy degree.

3.2. Statistical analysis

Individual logistic regressions were performed using the potential predictors listed in Table 2 and the SPLE first-time pass rate as the outcome. Females had higher odds of passing SPLE compared to males (OR 1.64; 95 % CI, 1.15–2.34; P = 0.0065). PharmD program and on-time graduation were significantly associated with higher passing rates (OR 1.99; 95 % CI, 1.37–2.89; P = 0.0003; and OR 4.16; 95 % CI, 2.76–6.27; P < 0.0001, respectively). Having more than two rotations in internal medicine or acute care areas was not significantly associated with pass rates. For each 0.5 increase in GPA, the odds of passing SPLE increase by 3.5 times (OR 3.53; 95 % CI, 2.83–4.42; P < 0.0001). Of the tests taken prior to university admission, the overall high school score, GAT score, and qualifying score were significantly associated with higher SPLE first-time pass rates, while the AAT score was not associated with higher pass rates (Table 2).

Table 2.

Logistic regression of potential factors associated with first-time SPLE passing status.

Characteristic	OR (95 % CI)	P-value
Sex, female	1.64 (1.15–2.34)	0.0065
Program, PharmD	1.99 (1.37–2.89)	0.0003
On-time graduation	4.16 (2.76–6.27)	<0.0001
>2 internal medicine/acute care rotation	1.89 (0.94–3.78)	0.0744
GPA, 0.5 unit	3.53 (2.83–4.42)	<0.0001
High school score, 5 units	1.82 (1.13–2.92)	0.0133
AAT score, 5 units	1.15 (0.94–1.41)	0.1742
GAT score, 5 units	1.27 (1.06–1.51)	0.0079
Qualifying score, 5 units	1.76 (1.23–2.52)	0.0021

AAT: Academic Achievement Test; CI: confidence interval; GAT: General Aptitude Test; GPA: grade point average; OR: odds ratio.

A multiple logistic regression model was developed using backward stepwise regression. GPA and GAT score were the only significant predictors associated with SPLE first-time pass rates (P < 0.0001 and P = 0.0002, respectively) (Table 3).

Table 3.

Multiple logistic regression model of potential factors associated with first-time SPLE passing status.

Characteristic	OR (95 % CI)	P-value
GPA, 0.5 unit	3.76 (2.97–4.75)	<0.0001
GAT score, 5 units	1.56 (1.23–1.97)	0.0002

CI: confidence interval; GAT: General Aptitude Test; GPA: grade point average; OR: odds ratio.

4. Discussion

The current research was set out with the aim of investigating the factors associated with the performance of applicants in the SPLE, utilizing a retrospective cohort study design within a single pharmacy institute in the Southern Region of Saudi Arabia. Specifically, it sought to determine factors that might affect SPLE performance, such as demographics and academic performance factors prior to admission to the college of pharmacy, as well as other post-admission factors. This study has shown that the overall SPLE pass rate among the study sample was 80 %. It was also shown in the present investigation that higher SPLE first-time pass rates were significantly associated with female gender, being enrolled in the PharmD program, on-time graduation, GPA, high school score, GAT score, and qualifying score when assessed using individual logistic regressions. Multiple logistic regression analysis revealed that GPA and GAT score were the only significant predictors associated with SPLE first-time pass rates.

Findings from the current study are consistent with our earlier observations, which showed that male applicants had lower SPLE pass rates when compared to female applicants (95.8 % vs. 97.5 %, p = 0.0221) (Alghamdi et al., 2022). Contrary to this finding, in a previous systematic review that assessed predictors of success for the North American Pharmacist Licensure Examination (NAPLEX) and of six studies that investigated the correlation between gender and NAPLEX score, only one study reported a higher mean score amongst the male students when compared to the female students (Park, Phillips, & Pavuluri, 2021). On a national level, and contrary to our findings, one study has reported a positive association between being male and SPLE scores (Alhifany et al., 2020). It is worth noting that education in most undergraduate programs in Saudi Arabia, including the current study setting, is gender segregated, which is an important potential factor that is worth investigating in future research.

It is not surprising that being enrolled in the PharmD program is a significant predictor associated with SPLE first-time pass rates when compared to enrollment in the BPharm program, given that applicants to pharmacy colleges compete for admission to the PharmD program, hence top-performing high school students tend to be accepted into the PharmD program. Additionally, in terms of the program structure, PharmD is a 6-year program, including a full year of internship, while BPharm is a five-year program with an additional four months of training (Almaghaslah et al., 2019). Although the curriculum for the two programs is identical in the first three years, there is more focus on clinical aspects of the later years in the PharmD program. Interestingly, no correlation between pharmacy program track (BPharm vs. PharmD) and SPLE score was reported in previous studies. It is worth noting that over the last few years, most pharmacy institutions in Saudi Arabia began the process of phasing out the BPharm program with a transformation toward solely offering the PharmD program as an entry-level degree (Almaghaslah et al., 2019), which was a result of the global influence that stimulated advancing pharmaceutical education in Saudi Arabia toward a more patient-centered approach.

Previous studies have demonstrated that pharmacy GPA and on-time graduation were positively associated with NAPLEX scores (Allen and Diaz, 2013, Chisholm-Burns et al., 2017), with GPA being the most significant predictor. This is in line with the findings of this study, where GPA and on-time graduation were the most significant predictors (P < 0.0001) in the individual logistic regression analyses. It is worth noting that NAPLEX focuses mainly on the clinical aspects, compared to SPLE, which is broader in scope. When multiple logistic regression analysis was performed, GPA remained the most significant predictor (P < 0.0001), along with student scores in the GAT test (P = 0.0002). It is important to note that GAT is a test designed by the National Center for Assessment (Qiyas) that measures the applicant's analytical and inferential learning abilities, how to perceive logical relationships and evaluation, and their problem-solving skills using mathematical concepts. This is different from the ATT, which is a test that measures student achievement on various science subjects that were learned during the high school years.

A limitation of this study is the retrospective nature of this investigation, which analyzed student records, hence causality cannot be inferred or established. Also, this study was conducted at a single pharmacy institution, meaning the generalizability of the study findings is limited to those with similar contexts.

In conclusion, the current research has shown that there is an association between higher SPLE first-time pass rates and female gender, being enrolled in the PharmD program, on-time graduation, GPA, high school score, GAT score, and qualifying score when assessed using individual logistic regression. Further research in this area is needed, as it might assist in informing the decision on selecting pharmacy admission criteria that will most likely result in better-performing students and graduates.

Funding

This work was supported by the Deanship of Scientific Research at King Khalid University [grant number GRP/23/44].

Credit authorship contribution statement

Wael A. Alghamdi: Writing – review & editing, Writing – original draft, Methodology, Funding acquisition, Formal analysis, Data curation, Conceptualization. Tahani M. Almeleebia: Writing – review & editing, Methodology, Funding acquisition, Data curation, Conceptualization. Mona A. Almanasef: Writing – review & editing, Writing – original draft, Methodology, Funding acquisition, Formal analysis, Conceptualization. Khalid M. Orayj: Writing – review & editing, Writing – original draft, Methodology, Funding acquisition, Formal analysis, Data curation, Conceptualization.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.