Abstract
Description of the Problem: The Multistate Pharmacy Jurisprudence Examination (MPJE) is a licensure requirement for pharmacists. National pass rates for this exam are variable and have recently been decreasing nationally. Current support for graduates in pharmacy law courses and MPJE test preparation tools varies between states and institutions.
Description of the Innovation: The Virginia Commonwealth University School of Pharmacy created an online, asynchronous continuing education (CE) course that provides content specific to Virginia pharmacy laws and regulations. The course is divided into six modules, aligned with MJPE competency statements.
Critical Analysis: Of the 158 recent graduates and practicing pharmacists transferring to the state who have taken the CE, 26 responded to the survey (response rate = 16.5%) on pass rate success and resources used in preparation for MJPE. The majority (96%) of those who completed the CE passed their next attempt on the MJPE with 20 participants taking it for the first time. Qualitative feedback was collected and evaluated, revealing response categories of practice scenarios, alignment to MPJE, program structure, and overall satisfaction. This limited cross-sectional data reports descriptive preliminary findings.
Implications: The institution will continue to offer this CE. The CE creates a revenue stream for the institution and provides a resource for passing the Virginia MPJE. There is limited generalizability.
Keywords: MPJE, Pharmacy licensure, Licensure exam preparation, Continuing education
Description of the Problem
Successfully passing the Multistate Pharmacy Jurisprudence Examination (MPJE) and the North American Pharmacist Licensure Examination (NAPLEX) is required to become a licensed pharmacist. The MPJE focuses on the graduates’ knowledge of and ability to apply federal and state pharmacy laws in pharmacy practice, licensure requirements, and general regulatory processes.1 Despite being an essential step to becoming a pharmacist, national MPJE pass rates have decreased over the last few years.2 Schools of pharmacy differ in methods for teaching pharmacy law and the specific NAPLEX and MPJE test preparation tools provided to students/graduates.3,4,5 The impact of course delivery and test preparation offerings on MPJE pass rates has been conflicting or they have not been correlated to MPJE performance. In Virginia specifically, MPJE pass rates have decreased since 2021 and now range from 50-90% across all schools of pharmacy in the state.2 This raises the question: should state-specific pharmacy law courses exist outside of the Doctor of Pharmacy curriculum as an MPJE preparation tool?
This problem led to the creation of providing a state-specific MPJE preparation tool. Faculty at Virginia Commonwealth University School of Pharmacy (VCU SOP) developed the virtual Virginia Pharmacy Law Continuing Education program (CE)6 as a resource for recent Doctor of Pharmacy graduates in the state of Virginia and pharmacists moving to Virginia preparing to take the Virginia MPJE for licensure. While printed and online MPJE preparation tools already existed, this comprehensive, state-focused law review course was the first of its kind to be self-directed, designed by educators, and peer-reviewed by practicing pharmacists. In addition, unlike other MPJE preparation tools, such as textbook reviews, it offered CE credit for completion of the course. This manuscript describes the development of the Virginia Pharmacy Law CE and a quality improvement project to analyze its impact on participants’ MPJE preparation.
Description of the Innovation
The Virginia Pharmacy Law CE is an online, asynchronous course that provides content specific to Virginia pharmacy laws and regulations.6 Faculty members and residents at VCU SOP developed the Virginia Pharmacy Law CE in collaboration with key stakeholders, including practicing pharmacists within the community, VCU Health’s CE office, a website developer, a CE coordinator, an online education consultant, and university legal support. The two faculty members spearheading its development implemented backward course design, which begins with creating learning objectives that match the desired knowledge and skills of the learners, building educational content from the end-planned result to the learning materials.7 In the case of the CE, the end goal was passing the MPJE, so learning objectives were mapped to the MPJE competency statements (Table 1).
Table 1.
Organization of the Virginia Pharmacy Law Continuing Education Program
| Module | Unit(s) | Learning Objectives | 2019-2022 MPJE Competency Statements |
|---|---|---|---|
| 1 – Course Overview | Course Overview Course Mechanics Approach to the Course |
Not Applicable | Not Applicable |
| 2 – The People and Place | The Place | Define pharmacy practice and the requirements for pharmacy permits Describe the operational requirements of a pharmacy practice setting |
2.2 Requirements and application procedure for the registration, licensure, certification, or permitting of a practice setting or business entity 2.3 Operational requirements for a registered, licensed, certified, or permitted practice setting |
| The People | List the requirements for pharmacy personnel licensure or certification Summarize the legal responsibilities of the pharmacist and other pharmacy personnel |
2.1 Qualifications, application procedure, necessary examinations, and internship for licensure, registration, or certification of individuals engaged in the storage, distribution, and/or dispensing of pharmaceutical products (prescription and non-prescription) 1.1 Legal responsibilities of the pharmacist and other pharmacy personnel |
|
| 3 – The Prescriptions | Who Can Prescribe? | Identify Virginia practitioners prescribing abilities and limitations | 1.3.2 Scope of authority, scope of practice, and valid registration of all practitioners who are authorized under law to prescribe, dispense, or administer pharmaceutical products, including controlled substances |
| How Prescribers Prescribe | Define prescription order requirements and mechanisms for issuance | 1.3.1 Prescription/order requirements for pharmaceutical products and the limitations on their respective therapeutic uses 1.3.4 Requirements for issuing a prescription/order |
|
| Limitations on Prescribing | Distinguish limitations for the issuance of controlled medications Recognize limitations for refilled medications, including controlled medications |
1.3.5 Requirements for the issuance of controlled substance prescriptions/orders 1.3.6 Limits of a practitioner’s authority to authorize refills of a pharmaceutical product, including controlled substances |
|
| 4 – The Dispensing | Prescription Order to Completed Preparation | Recognize procedures necessary to properly dispense a pharmaceutical product pursuant to a prescription Identify conditions when a prospective drug use review is conducted prior to dispensing Recognize labeling requirements for dispensing pursuant to a prescription order Explain conditions when a preparation or device may not be dispensed |
1.4 Procedures necessary to properly dispense a pharmaceutical product, including controlled substances, pursuant to a prescription/drug order 1.4.4 Conditions under which prospective drug use review is conducted prior to dispensing 1.4.6 Requirements for the labeling of pharmaceutical products and preparations dispensed pursuant to a prescription/order 1.4.7 Conditions under which a pharmaceutical product, preparation, or device may not be dispensed |
| Dispensing Completed Preparation to the Patient | Outline conditions regarding the ability to return or reuse pharmaceutical products Describe requirements and documentation for patient counseling List requirements and documentation for delivery Identify requirements for reporting to the prescription monitoring program (PMP) |
1.4.11 Conditions regarding the return and/or reuse of pharmaceutical products, preparations, bulk drug substances/excipients, and devices 1.5 Conditions for making an offer to counsel or counseling appropriate patients, including the requirements for documentation 1.4.14 Requirements for reporting to PMP, accessing information in a PMP and the maintenance of security and confidentiality of information accessed in PMPs |
|
| Dispensing in Special Situations | List requirements for the transfer of an existing prescription from one pharmacist to another Explain conditions when a prescription order may be filled or refilled without a prescription order Describe conditions when a pharmacist may dispense a non-prescription product, including controlled substances |
1.4.2 Requirements for the transfer of existing prescription/order information from one pharmacist to another 1.4.3 Conditions under which a prescription/order may be filled or refilled 1.6 Requirements for the distribution and/or dispensing of non-prescription pharmaceutical products, including controlled substances |
|
| 5 – The Inventory and Records | Ordering and Inventory | State the legal requirements for ordering Schedule II drugs in a pharmacy with an official written order Compare inventory requirements based on drug Schedules |
2.3.2 Requirements for the possession, storage, and handling of pharmaceutical products, preparations, bulk drug substances/excipients, and devices, including controlled substances 1.7.1 Requirements pertaining to controlled substance inventories |
| Storage and Disposal | Identify the storage requirements of prescription drugs, expired drugs, and devices/paraphernalia List the acceptable methods of drug disposal |
2.3.2 Requirements for the possession, storage, and handling of pharmaceutical products, preparations, bulk drug substances/excipients, and devices, including controlled substances Investigational new drugs, repackaged or resold drugs, sample pharmaceuticals, recalls, and outdated pharmaceutical products 1.1.1 Responsibilities for inventory, loss and/or theft of prescription drugs, the destruction/disposal of prescription drugs and the precedence of Local, State, or Federal requirements |
|
| Record Keeping and Health Records Privacy | Describe the content, maintenance, storage, and reporting requirements for records in the operation of a pharmacy Compare the record-keeping requirements pertaining to controlled substances State the confidentiality requirements without a patient’s written authorization |
1.7.2 Content, maintenance, storage, and reporting requirements for records required in the operation of a pharmacy 1.2.1 Requirements and record keeping in relation to the ordering, acquiring, and maintenance of all pharmaceutical products and bulk drug substances/excipients 1.7.1 Requirements pertaining to controlled substance inventories 1.7.3 Requirements for protecting patient confidentiality and confidential health records |
|
| 6 – The Extension Beyond Traditional Pharmacy | Compounding Pharmacy | Describe the requirements for distributing compounded drug products Identify the requirements of outsourcing facilities to practice pharmacy |
1.2.2 Requirements for distributing pharmaceutical products and preparations, including the content and maintenance of distribution records 1.4.9 Requirements for compounding pharmaceutical products |
| Institutional Pharmacy | Explain the lawful practice of pharmacy services provided to hospitals, including drug product distribution, central and remote order processing, automated dispensing cabinets, non-pharmacist access to drug products, and emergency kits List the requirements for the use of investigational drug therapy Characterize pharmacy services provided to long-term care facilities (LTCF), community services board facilities (CSB), behavioral health authority facilities (BHA), or program of all-inclusive care for the elderly facilities (PACE), including drug product distribution, repackaging, and emergency drugs or stat-drugs |
1.2.2 Requirements for distributing pharmaceutical products and preparations, including the content and maintenance of distribution records 1.4.10 Requirements for emergency kits 1.4.12 Procedures and requirements for systems or processes whereby a non-pharmacist may obtain pharmaceutical products, preparations, bulk drug substances/excipients, and devices 1.4.13 Procedures and requirements for establishing and operating central processing and central fill pharmacies 1.4.15 Requirements when informed consent must be obtained from the patient and/or a duty to warn must be executed |
|
| Expansion of Pharmacy and Other Settings | Describe the requirements for pharmacists to participate in collaborative practice agreements Explain the requirements for non-pharmacist distribution of controlled substances Identify settings outside of community pharmacy that engage in the distribution of pharmaceutical products, including nuclear pharmacies, infirmaries, animal shelters, and correctional facilities List the requirements for approval of non-traditional pharmacy settings to engage in the distribution of pharmaceutical products, including manufacturers, wholesalers, warehousers, medical equipment suppliers, third-party logistics providers, and non-resident pharmacies |
1.3.3 Conditions under which the pharmacist participates in the administration of pharmaceutical products, or in the management of patients’ drug therapy 1.4.15 Requirements when informed consent must be obtained from the patient and/or a duty to warn must be executed 1.2.2 Requirements for distributing pharmaceutical products and preparations, including the content and maintenance of distribution records 1.4.12 Procedures and requirements for systems or processes whereby a non-pharmacist may obtain pharmaceutical products, preparations, bulk drug substances/excipients, and devices 1.4.15 Requirements when informed consent must be obtained from the patient and/or a duty to warn must be executed 2.2.1 Requirements for registration, license, certification, or permitting of a practice setting |
The overall CE is divided into six modules, starting with an overview followed by content related to five core areas of pharmacy law (i.e. the physical pharmacy department and personnel, prescriptions, dispensing, inventory and recordkeeping, and pharmacy in other healthcare settings). Each module begins with an introductory page with the learning objectives, additional resource links, and five pre-quiz questions. After answering the pre-quiz questions, the participant can move to the module’s content. Each module is divided into two to three units for more manageable learning. Each unit contains a 10-45 minute video lecture, transcript, and five post-quiz questions. A reflective practice scenario that prompted the participant to give an optional short-answer response was included in the unit content when appropriate. The multiple-choice pre-quiz questions provided learners with feedback on whether their response was correct or incorrect, whereas post-quiz question feedback included the correct answer and rationale. Quiz questions were multiple-choice with four to five possible answer choices.
Each module was assigned a lead creator, who was a teaching-intensive faculty member within the School of Pharmacy with expertise in backward design, writing exam questions, and creating application cases. Lead creators were chosen for their pharmacy practice-based experience and were licensed Virginia pharmacists. For example, one lead creator designed the Dispensing module due to her background as a community pharmacist-in-charge for four years before joining as faculty. Based on the MPJE-mapped learning objectives of the CE, the lead creator developed module materials by reviewing Virginia pharmacy laws and regulations. The National Association of Boards of Pharmacy (NABP) collaborates with each state’s board of pharmacy (BOP) in the creation of their state specific’s MPJE content. The Virginia BOP, due to this conflict, was not able to provide assistance during the development of this CE to prevent compromising the exam integrity of the MPJE. Therefore, creators utilized publicly available resources from the Board of Pharmacy, such as guidance documents, to support their interpretation of the laws when needed.
Once a module’s content was developed by the lead creator, a peer reviewer was selected for that module. Peer reviewers were volunteer, practicing pharmacists selected for the CE module based on their area of expertise. Peer reviewers were provided a reviewer guide via email to prompt feedback regarding: the alignment of the module’s learning objectives with the associated MPJE competency statements, missing topics, unnecessary or out-of-place content, accuracy and relevancy of the content, and clarity of the presentation, and quiz questions and pharmacy practice example(s). The lead creator responded to the reviewer’s comments and edited the module’s materials as needed. Once materials were finalized, the lead creator recorded video lectures and created transcripts for the module using Descript (Descript Inc, San Francisco, CA). The website developer, with the help of a programmer, posted the module materials, created the domain, and constructed the website.
Each module needed six to eight weeks to be developed by the lead creator, two weeks for the peer review process, and then two to three weeks for website integration and programming. Beyond personnel resources for its development, the Virginia Pharmacy Law CE requires continuous financial and personnel support for a website domain, ACPE accreditation, and administrative costs. Even with these costs, the program has become a source of revenue with approximately 230 course purchases between its start in June 2020 and December 2022, when the CE participant list was acquired for survey deployment. The cost of the Virginia Pharmacy Law CE is $150 per participant. Students enrolled at VCU SOP are offered the course at a reduced rate of $40 during their first year and fourth year. Participants can log into the course multiple times, over one year from the purchase date, to access the course materials to facilitate asynchronous, self-paced learning. This study was deemed exempt by VCU Institutional Review Board.
Critical Analysis
In March 2023, a survey questionnaire was developed and distributed electronically through Qualtrics (Qualtrics, Provo, UT) to participants who had completed the CE course and taken the MPJE. The questionnaire was developed by faculty, with no pilot testing, for the purpose of quality improvement of the CE course. The survey was sent to the email used by participants who registered for the CE between June 2020 and December 2022; two reminder emails were sent over one month before the survey closed. Participants were asked a maximum of 25 questions, with some participants having fewer questions based on their answers and skip logic for the survey. Those questions included the number of their MPJE attempt(s) and performance, MPJE preparation details, perceptions of the Virginia Pharmacy Law CE, and demographics. A total of 158 CE participants were invited to complete the survey, with 26 participants (response rate = 16.5%) providing responses before survey closure at the end of April 2023. The majority of survey respondents graduated in 2020-2022 (62%) and took the MPJE in the last two years of 2020-2022 (77%). Most attended pharmacy school in Virginia (62%), the majority were VCU SOP alumni (58%), and had between 1-5 years of pharmacy intern or technician experience (50%). Respondents reportedly spent an average of 22 days preparing for the Virginia MPJE and an average of 15.4 hours per week on the Virginia Pharmacy Law CE.
Of the 26 respondents, 96% of participants (n=24) passed the Virginia MPJE immediately following the use of the CE. Of those 24 participants, 20 used the CE for their first MJPE attempt; four participants completed the CE after a failed MPJE attempt and then passed their MJPE. One participant used the CE to prepare for multiple MPJE attempts, and one participant did not provide information on the number of attempts required to pass the MPJE. All respondents reported the use of other study resources besides the Virginia Pharmacy Law CE, with the majority using a textbook or review book (19%), Virginia pharmacy laws and regulations (20%), Virginia Board of Pharmacy website and resources (20%), and a practice MPJE exam (15%).
Twenty-four (24) participants answered the perception questions with 92% (n=22) agreeing that they would recommend the CE program to others. On a scale of 0-10 (0 being not helpful at all to 10 being the most helpful), participants reported an average score of 8 for the Virginia Pharmacy Law CE being helpful for MPJE preparation. Sixteen respondents provided 46 comments on three open-ended questions about the quality and content of the CE: (1) What is the least helpful component of the Virginia Pharmacy Law Review online CE course that aided your preparation for the Virginia MPJE? (2) What is the most helpful component of the Virginia Pharmacy Law Review online CE course that aided your preparation for the Virginia MPJE? (3) What changes do you recommend for the Virginia Pharmacy Law Review online CE course? Thematic analysis was conducted on responses to the open-ended questions. Two faculty members, one lead creator and one faculty member outside of the CE development team, independently reviewed the data and, through a process of data reduction and data compilation, data were categorized using an inductive approach. The reviewer dyad met to resolve differences in theme coding and reach consensus.8,9 Four categories were identified: practice scenarios, alignment to MPJE, program structure, and overall satisfaction (Table 2). If needed, responses including more than one topic were separated into fragments and counted based on the category represented.
Table 2.
Thematic Analysis of the Virginia Pharmacy Law Continuing Education Program
| Category and Its Description | Insights | Representative Quotes |
|---|---|---|
| Practice Scenarios Comments relating to the pharmacy practice scenario examples in the modules. |
2 positive comments related to practice questions | I liked the practice questions |
| 5 comments providing constructive feedback | ||
| There should be an entire section on federal vs. state laws, then practice examples of different scenarios. For example, when to transfer, how many transfers, how many days supply all by control statuses | ||
| Lacked examples of application of law to common or frequent daily pharmacy activities | ||
| It would be helpful to have more practice questions that are in the style of the MPJE questions after the modules. | ||
| Add more application-based scenarios and questions to assist with exam preparation. | ||
| Longer, more review questions | ||
| Alignment to MPJE Comments related to how the module content was aligned to the MPJE blueprint and relevance to MPJE questions. |
6 positive comments | I felt very prepared for the state portion of the test. |
| It had several questions on it that were relevant for the exam. | ||
| …the information was super relevant. | ||
In response to most helpful components:
| ||
| 9 comments providing constructive feedback | Lack of clear review for controlled substances. | |
| Not memorable in aiding to pass the exam on attempt #2 | ||
| For context, I am from out of state and last worked in community 3 years prior to graduation so I barely remembered my own state laws. Lack of clear review for controlled substances. There should be an entire section on federal vs. state laws, then practice examples of different scenarios. For example, when to transfer, how many transfers, how many days supply all by control statuses. I took this 2 years ago so my memory is not as good. However, I do not feel it was worth the money. I reviewed the “red book” given to me by VCU students and this was helpful. However, the primary focus of my exam was on controlled substances and I felt this course did a poor job of reviewing them. | ||
| Adding information about federal laws | ||
| …make it better and applicable for passing the exam, not just information | ||
| I was not as prepared for some of the long-term care facility questions. Most students do not have experience working in a LTC facility so the rules are very different than retail or hospital. | ||
| I guess I would just recommend the course is updated every year or two to ensure everything is up to date. | ||
In response to least helpful components:
| ||
| Program Structure Comments related to the organization and learning components (such as video lectures, video lecture transcripts, etc) |
6 positive comments | I liked the grouping of things that helped me remember |
| The transcript being provided for each lecture. | ||
| The information was presented in a way that I understood and was able to remember, unlike the review books and notes I studied for my first time. | ||
| Ease of access | ||
| Giving me a structure to study, honestly giving me a program to work through and sit down and focus | ||
| The videos | ||
| 2 comments providing constructive feedback | Maybe one suggestion is to update it to the most current competency statement as of 2023 due to the recent update from the NABP. | |
In response to what could be improved:
| ||
| Overall Satisfaction Comments related to respondents’ overall impressions of the CE program. Comments that didn’t address specific components of the program were included in this theme. |
20 positive comments | I honestly believe the entire course was critical, especially since I came from a different state. |
| … it was all helpful. | ||
| I loved the whole course | ||
| From what I remember everything was spot on with the information. | ||
| Just having the comprehensive review was helpful - to be honest, I am not sure if there was study material that could have made me feel confident going into the exam. I came out of the exam feeling like a retake was necessary, but ended up passing. | ||
| Loved the whole course | ||
| Good overall review often citing important aspects of law. | ||
| Comprehensive review | ||
| I found all the modules to be very helpful. | ||
| I would not have passed my second try without this review course. It was immensely helpful from start to finish. | ||
| … it all works well. | ||
| I was happy with the course and I felt prepared. | ||
| The module is very helpful overall |
This cross-sectional survey from a single institution is limited to descriptive analysis and not inferential analysis. Therefore, conclusions on the effectiveness of the program are inherently limited. Additionally, the response rate restricts the conclusions. Survey results are not generalizable to the total population as the survey respondents were limited and may not represent the whole population. However, the survey results are encouraging due to the high percentage of CE participants who passed the exam on their first attempt.
Next Steps
The Virginia Pharmacy Law CE continues to support graduates in passing the MJPE and is financially beneficial to the institution. Since the online course design in 2020, the MJPE competency statements were updated in October 2023.1 Although the CE has been continuously updated with changes in Virginia laws and regulations on pharmacy practice, the learning objectives have yet to be mapped to the new MPJE competency statements due to the significant effort required to reorganize the CE’s modules and units. The uncertainty of the future use of the MPJE10-13 and potential future new editions of the competency statements does not decrease the benefit of this resource for participants. While this preliminary innovation is in its early stages, the pilot data currently supports other states’ consideration of offering similar online, asynchronous state-specific pharmacy law CEs.
Acknowledgments
Conflicts of Interest: None
Funding/support: None
Disclaimer: The statements, opinions, and data contained in all publications are those of the authors.
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