The NAPLEX: evolution, purpose, scope, and educational implications

Interrogating Consequential Validity Evidence in NAPLEX Studies Involving the Use of Demographic Variables

OBJECTIVE

to review the purpose, methods, and discussion of student demographics related to North American Pharmacist Licensure Examination (NAPLEX) performance; demographic characteristics, significant findings, and related text were extracted from each reviewed article as evidence of consequential validity.

FINDINGS

Nine articles met the inclusion criteria. Prior degree attainment (n = 8, 88.9%), age (n = 6, 66.7%), race/ethnicity (n = 6, 66.7%), and sex (n = 5, 55.6%) were the most common demographic variables included. One study found that prior degree attainment was negatively related to NAPLEX performance and no studies using this variable discussed their findings. Three studies found significant relationships between age and NAPLEX performance, attributing differences to older students for "unique psychosocial challenges and competing responsibilities" "greater maturity" and being more "professional." Measures of race/ethnicity differed in every study, with 3 reporting significant findings and 2 discussing their findings. Studies referenced literature suggesting that "minority groups" tended to score lower on standardized examinations while others referenced literature that suggests "standardized testing may not be predictive of the performance of minority students." Sex was not related to NAPLEX performance nor was it discussed in any studies.

SUMMARY

Consequential validity evidence is a critical yet underreported aspect of NAPLEX evaluation in pharmacy education. How demographic variables are selected, utilized, and discussed warrants further exploration and consideration by educators, scholars, and practitioners as these decisions can have important sociocultural and political implications.

Association Between Accreditation Era, North American Pharmacist Licensure Examination Testing Changes, and First-Time Pass Rates

Objective. To estimate whether first-time pass rates on the North American Pharmacist Licensure Examination (NAPLEX) have been influenced by the number of pharmacy programs founded since 2000, the programs' accreditation era, and the changes to the blueprint as well as changes to the testing conditions and passing standards implemented by the National Association of Boards of Pharmacy (NABP) beginning in 2015.Methods. This was a retrospective, observational cohort study using publicly published data. The number of programs and pass rates were collected from 2008 to 2020. Programs reporting pass rates from 2016 to 2020 were eligible. Accreditation era was defined as programs accredited before or after 2000. Pass rates were categorized into NAPLEX tests administered before or after 2015. Statistical analyses were conducted for comparisons.Results. Pass rates were initially found to decline as the number of programs rose. First-time pass rates of programs accredited before 2000 were higher than pass rates of programs accredited after 2000 every year after 2011. Only 40% of the programs accredited after 2000 exceeded the national average between 2016-2020. Blueprint changes implemented in 2015 and the changes to testing conditions plus passing standards implemented in 2016 had a greater effect on pass rates than the number of programs or applicants.Conclusion. Programs accredited after 2000 generally had lower first-time NAPLEX pass rates. Even so, blueprint changes and changes to the testing conditions plus passing standards instituted by the NABP were more important predictors of the decline of first-time NAPLEX pass rates. Stakeholders should collaborate and embrace best practices for assessing practice-ready competency for licensure.

Comparison of Saudi Pharmacist Licensure Examination (SPLE) Pass Rates by Institution and Applicant Characteristics

In 2019, the Saudi Pharmacist Licensure Examination (SPLE) was first administered to all pharmacy graduates and served as one of the prerequisites for obtaining a pharmacist license. The objective of this study was to evaluate whether institution and applicant characteristics are associated with first-time SPLE success. Passing status for 2284 SPLE first-time applicants was obtained from online public data for the years 2019 and 2020. The data included applicant sex, institution type (public vs. private), and college establishment year (2006 or earlier vs. after 2006). Overall, the SPLE first-time pass rate in 2020 was significantly higher than in 2019 (98.0 vs. 95.9%; p = 0.0062). Applicants from pharmacy colleges established in or before 2006 had a higher SPLE first-time pass rate, compared to those from pharmacy colleges established after 2006 (98.2 vs. 95.2%; p < 0.0001). The pass rate for male applicants was lower compared to female applicants (95.8 vs. 97.5%; p = 0.0221). The results of logistic regression showed that exam year (2020 vs. 2019), applicant sex (female vs. male), and pharmacy college establishment year (≤2006 vs. >2006) were statistically significant predictors. Further studies are needed in the upcoming years when more cumulative data are available.

A scoping review of the methods and processes used by regulatory bodies to determine pharmacists' readiness for practice

BACKGROUND

There is an expectation from government, regulatory bodies, patients, the public, and other healthcare professions that pharmacists are competent professionals who can practice independently. Regulation of the profession requires pharmacy graduates to register with a recognised regulatory body before being considered 'ready to practise' independently.

OBJECTIVE

To examine the methods and processes used by national regulatory bodies to determine pharmacists' readiness to practise.

METHODS

A scoping review was conducted using three electronic databases (Embase, Scopus, CINAHL) and websites of national regulatory bodies. Articles were eligible for inclusion if they described the methods and processes used by regulatory bodies to determine pharmacists' readiness to practise. Data were extracted relating to readiness to practise, the registration exam and the role of newly qualified pharmacists, post-registration. Extracted data were collated using narrative descriptive summaries and accompanying tables.

RESULTS

Identified data sources referred to registration of pharmacists across 11 different countries. No sources provided a definition for the term 'ready to practise'. Ten countries were identified as holding a registration examination with varying formats and curricula. Written and oral exams, competency based written assessments, Objective Structured Clinical Examinations and a combination of these were identified with written exam being the most popular (n = 8). In all but one country, the regulator was responsible for delivery of the exam. In most cases (n = 7), the exam was mapped to a pre-defined set of competencies with only a few (n = 4) explaining how these competencies were developed. Only two sources made reference to the role of the newly qualified pharmacist post-registration.

CONCLUSION

The review has established a paucity of research and publicly available information on the methods and processes used by national regulators to determine pharmacists' readiness to practise. There is no pharmacy definition of being 'ready to practise'. Assessment methods vary widely and, currently, no gold standard is apparent.

Pharmacy in Flight: Impact of Clinical Pharmacist in Prehospital Care

Critical care and emergency medicine pharmacists play vital roles in the hospital setting but have historically had limited involvement in prehospital emergency services. The Mississippi Center for Emergency Services added a critical care pharmacist to the interprofessional prehospital team. This article characterizes the role of the prehospital clinical pharmacist.

Systematic Review of Predictors of Success for the North American Pharmacist Licensure Examination

Objective. Studies have examined possible predictors of success on the North American Pharmacist Licensure Examination (NAPLEX). This systematic review investigated the literature on potential predictors of success on the NAPLEX.Findings. Articles were included in the review if they studied student characteristics and academic performance as independent variables and NAPLEX scores and/or pass rates as an outcome. Data were extracted from each article for students' demographics or variables, sample size, methods of statistical analyses, and results reporting correlation or predictability. From 40 articles retrieved from the initial search and sorting, 20 studies were included in the final review per inclusion criteria. Three studies included all the pharmacy programs, 15 were single-institution studies, two were multi-institution studies, and four had been published as posters. Among 30 different variables identified as potential predictors of success on the NAPLEX, the most examined variables were student age at matriculation, having a prior degree, Pharmacy College Admission Test (PCAT) scores, cumulative pharmacy school grade point average (GPA), overall Pharmacy Curriculum Outcomes Assessment (PCOA) scores, and PCOA content areas scores. Positively correlated factors included PCAT scores, not having a prior degree, prepharmacy and pharmacy school GPA, institutional characteristics, and PCOA scores. Negatively correlated factors included older age at admission.Summary. Cumulative pharmacy school GPA and PCOA scores were predictors of NAPLEX success consistently in the studies. The effects of preadmission student characteristics on NAPLEX success varied and were not consistently correlated or predictive.

Assessing professional competence in optometry - a review of the development and validity of the written component of the competency in optometry examination (COE)

BACKGROUND

Credentialing assessment for overseas-educated optometrists seeking registration in Australia and New Zealand is administered by the Optometry Council of Australia and New Zealand. The aim was to review the validation and outcomes of the written components of this exam to demonstrate credentialing meets entry-level competency standards.

METHODS

The Competency in Optometry Examination consists of two written and two clinical parts. Part 1 of the written exam comprises multiple choice questions (MCQ) covering basic and clinical science, while Part 2 has 18 short answer questions (SAQ) examining diagnosis and management. Candidates must pass both written components to progress to the clinical exam. Validity was evaluated using Kane's framework for scoring (marking criteria, item analysis), generalization (blueprint), extrapolation (standard setting), and implications (outcome, including pass rates). A competency-based blueprint, the Optometry Australia Entry-level Competency Standards for Optometry 2014, guided question selection with the number of items weighted towards key competencies. A standard setting exercise, last conducted in 2017, was used to determine the minimum standard for both written exams. Item response theory (Rasch) was used to analyse exams, produce reliability metrics, apply consistent standards to the results, calibrate difficulty across exams, and score candidates.

RESULTS

Data is reported on 12 administrations of the written examination since 2014. Of the 193 candidates who sat the exam over the study period, 133 (68.9%) passed and moved on to the practical component. Ninety-one (47.2%) passed both the MCQ and SAQ exams on their first attempt. The MCQ exam has displayed consistently high reliability (reliability index range 0.71 to 0.93, average 0.88) across all 12 administrations. Prior to September 2017 the SAQ had a set cutscore of 50%, and the difficulty of the exam was variable. Since the introduction of Rasch analysis to calibrate difficulty across exams, the reliability and power of the SAQ exam has been consistently high (separation index range 0.82 to 0.93, average 0.86).

CONCLUSIONS

The findings from collective evidence support the validity of the written components (MCQ and SAQ) of the credentialing of the competency of overseas-educated optometrists in Australia and New Zealand.

'Both useful in their own way': Video podcasts and typed solutions as feedback on undergraduate pharmaceutical calculations skills assessment

INTRODUCTION

Accurately completing pharmaceutical calculations is a core professional skill for pharmacists. To date, few studies have focused on to providing feedback on calculations, or the role of technology in feedback provision. This study aimed to develop a theory-informed video podcast-based method of providing formative feedback and evaluate student perceptions.

METHODS

First-year pharmacy students (n = 53) completed a formative pharmaceutical calculations assessment. Two forms of feedback were designed and evaluated; typed solutions (traditional format commonly used/seen in textbooks) and video podcasts informed by instructional design theory (novel format).

RESULTS

A survey was completed by 70% (37/53) of students. Specific features of video podcasts reported useful included hearing reasoning, and the ability to pause and rewind. Most (76%) reported positive attitudes towards video podcasts, considered them useful (75%) and helpful for learning (79%). A comparable number (76% and 71% respectively) felt positively about typed solutions. The majority (51%) preferred to receive both types rather than podcasts alone (24%), or typed solutions alone (8%). Free-text responses indicated both were used in different ways; typed solutions for quick verification and video podcasts for clarification.

CONCLUSIONS

Video podcasts appear to be a potentially helpful additional method of delivering feedback that afford specific advantages. They can be readily developed by faculty with minimal expense/difficulty. However, as respondents indicated that they used both kinds of feedback in different ways to support their learning, and indicated a preference to receive both types, they should be considered an addition rather than replacement for typed solutions.

An Exploratory Analysis of PharmD Program Value Using the Tuition: Licensure Index

Objective. To assess the value of a Doctor of Pharmacy (PharmD) program using the Tuition: Licensure Index (TLI), a de novo metric combining tuition and licensure pass rates. Methods. The TLI is a ratio of program tuition and licensure pass rates, where separate indices are derived for the North American Pharmacist Licensure Examination or NAPLEX (ie, TLI-N) and the Multistate Pharmacy Jurisprudence Examination (ie, TLI-M). The TLI can be further nuanced depending on use of in-state (ie, TLI-Ni and TLI-Mi) or out-of-state (ie, TLI-No and TLI-Mo) tuition. The TLI-N for the 2018 cohort was used in this analysis. Total program tuition and NAPLEX pass rates were obtained from publicly available sources. Differences in traditional vs accelerated and public vs private programs were examined using the TLI-N categories "one or less" and "greater than one." Results. While differences in TLI-Ni category (ie, "one or less" and "greater than one") for traditional vs accelerated PharmD programs were not significant, a major difference was found in the TLI-Ni category for public vs private programs. No differences in the TLI-No category for public vs private or for traditional vs accelerated programs were found. Conclusion. In-state public (vs private) PharmD programs may be preferable for optimizing value. Prospective students are encouraged to consider a school's tuition and licensure pass rates when selecting a PharmD program.

Impact of Pharmacy School Characteristics on NAPLEX First-time Pass Rates

Objective. To assess the impact of pharmacy school characteristics on the pass rates of students taking the North American Pharmacist Licensure Examination (NAPLEX) for the first time. Methods. A retrospective review of NAPLEX first-time pass rates, pharmacy school characteristics and percent of total graduating class who matched for a first postgraduate year (PGY1) residency was performed for 2014, 2015, and 2016. All US colleges of pharmacy accredited as of July 2017 were included. Independent samples t tests, paired samples t tests, correlational analysis, and multiple linear regression were conducted. Results. The first-time pass rates on the NAPLEX were significantly higher for the following: schools located within an academic health center; schools established before 2000, and public schools. The 2016 NAPLEX first-time pass rate was significantly higher for schools with a traditional four-year program structure versus an accelerated three-year structure. Also, a school's first-time pass rate on the NAPLEX was positively, significantly correlated with percentage of fourth-year students who matched for a PGY1 residency and being located within an academic health center. The NAPLEX first-time pass rate for the previous year and percent of the total graduating class that matched for a PGY1 residency were significant predictors in the final regression models for 2015 and 2016 NAPLEX first-time pass rates. Conclusion. While differences in certain program characteristics was coorelated with NAPLEX pass rate, many of these factors are not modifiable. Programs can proactively and critically evaluate their educational programs and the readiness of their students to sit for the NAPLEX.

Development and validation of a written credentialing examination for overseas-educated dietitians

AIM

Health professionals seeking employment in foreign countries are commonly required to undertake competency assessment in order to practice. The present study aims to outline the development and validation of a written examination for Dietetic Skills Recognition (DSR), to assess the knowledge, skills, capabilities and professional judgement of overseas-educated dietitians against the competency standards applied to dietetic graduates in Australia.

METHODS

The present study reviews the design, rationale, validation and outcomes of a multiple choice question (MCQ) written examination for overseas-educated dietitians based on 5 years of administration. The validity of the exam is evaluated using Messick's validity framework, which focuses on five potential sources of validity evidence-content, internal structure, relationships with other variables, response process and consequences. The reference point for the exam pass mark or "cutscore" is the minimum standard required for safe practice.

RESULTS

In total, 114 candidates have completed the MCQ examination at least once, with an overall pass rate of 52% on the first attempt. Pass rates are higher from countries where dietetic education more closely reflects the Australian model. While the pass rate for each exam tends to vary with each cohort, the cutscore has remained relatively stable over eight administrations.

CONCLUSIONS

The findings provide important data supporting the validity of the MCQ exam. A more complete evaluation of the validity of the exam must be sought within the context of the whole DSR program of assessment. The DSR written component may serve as a model for use of the MCQ format for dietetic and other professional credentialing organisations.

Creating an Arms Race? Examining School Costs and Motivations for Providing NAPLEX and PCOA Preparation

Objective. To examine the extent of financial and faculty resources dedicated to preparing students for NAPLEX and PCOA examinations, and how these investments compare with NAPLEX pass rates. Methods. A 23-item survey was administered to assessment professionals in U.S. colleges and schools of pharmacy (C/SOPs). Institutions were compared by type, age, and student cohort size. Institutional differences were explored according to the costs and types of NAPLEX and PCOA preparation provided, if any, and mean NAPLEX pass rates. Results. Of 134 C/SOPs that received the survey invitation, 91 responded. Nearly 80% of these respondents reported providing some form of NAPLEX preparation. Significantly higher 2015 mean NAPLEX pass rates were found in public institutions, schools that do not provide NAPLEX prep, and schools spending less than $10,000 annually on NAPLEX prep. Only 18 schools reported providing PCOA preparation. Conclusion. Investment in NAPLEX and PCOA preparation resources vary widely across C/SOPs but may increase in the next few years, due to dropping NAPLEX pass rates and depending upon how PCOA data are used.

Implementation of an integrated longitudinal curricular activity for graduating pharmacy students

OBJECTIVES

To evaluate whether a novel integrated longitudinal curricular activity to prepare graduating doctor of pharmacy (PharmD) students for 2 comprehensive examinations was successful, and to assess whether it engaged other pharmacy students in curricular discussion and learning.

DESIGN

Thirty-eight of 91graduating third-year (P3) students in a PharmD program formed 11 teams to create and present pharmacotherapeutic posters to their peers. The impact of the novel activity on graduating students' performance on the North American Pharmacist Licensure Examination (NAPLEX) and a comprehensive commercial examination was assessed. All first-year (P1), second-year (P2), and P3 students reviewed and discussed the content of each poster.

ASSESSMENT

Participants in the integrated longitudinal curricular activity performed better than nonparticipants on the commercial examination (p=0.023) and NAPLEX (p=0.033). However, regardless of participation, commercial examination scores predicted a significant amount of variance (ie, 34%) in NAPLEX scores. The P3 participants (83%) believed the curricular activity assisted them in their NAPLEX preparation, while 75% of P1 students, 79% of P2 students, and 80% of P3 students agreed that poster review provided an effective summary of different disease states. Ninety percent of faculty poster evaluators reported that the posters were professional, and all evaluators agreed that participants effectively conveyed their message to the intended audience.

CONCLUSION

The integrated longitudinal curricular activity provided a positive learning environment for all pharmacy students and may have better prepared graduating students' for the NAPLEX.

Educational testing validity and reliability in pharmacy and medical education literature

OBJECTIVES

To evaluate and compare the reliability and validity of educational testing reported in pharmacy education journals to medical education literature.

METHODS

Descriptions of validity evidence sources (content, construct, criterion, and reliability) were extracted from articles that reported educational testing of learners' knowledge, skills, and/or abilities. Using educational testing, the findings of 108 pharmacy education articles were compared to the findings of 198 medical education articles.

RESULTS

For pharmacy educational testing, 14 articles (13%) reported more than 1 validity evidence source while 83 articles (77%) reported 1 validity evidence source and 11 articles (10%) did not have evidence. Among validity evidence sources, content validity was reported most frequently. Compared with pharmacy education literature, more medical education articles reported both validity and reliability (59%; p<0.001).

CONCLUSION

While there were more scholarship of teaching and learning (SoTL) articles in pharmacy education compared to medical education, validity, and reliability reporting were limited in the pharmacy education literature.

Reliability and credibility of progress test criteria developed by alumni, faculty, and mixed alumni-faculty judge panels

OBJECTIVE

To compare the reliability and credibility of Angoff-based, absolute criteria derived by faculty, alumni, and a combination of alumni and faculty judge panels.

METHODS

Independently, faculty, alumni, and mixed faculty-alumni judge panels developed pass/fail criteria for an 86-item test. Generalizability and decision studies were performed. Root mean square errors (RMSE) and 95% confidence intervals were calculated for reliability and credibility assessment. School graduate performance upon the North American Licensure Examination (NAPLEX) was the comparator for credibility assessment.

RESULTS

RMSEs were 1.06%, 1.42%, and 2.32% for the alumni, faculty, and mixed judge panels respectively. The school's NAPLEX pass rate was 97.5%. This rate triangulated well with the faculty judge panel (pass rate = 93.9%, CI95% = 87.1%-98.2%), but did not with either mixed judge or alumni judge panels.

CONCLUSIONS

Faculty-derived criteria offer superior pass/fail decision defensibility relative to both alumni derived and mixed faculty-alumni derived criteria.

Evaluation of Croatian community pharmacists' patient care competencies using the general level framework

OBJECTIVES

To assess Croatian community pharmacists' patient care competencies using the General Level Framework (GLF).

METHODS

The competencies of 100 community pharmacists working in 38 community pharmacies were evaluated using an adapted version of the GLF.

RESULTS

Pharmacists demonstrated the best performance in the competency areas drug specific issues and provision of drug products; the poorest performance was in the competency areas evaluation of outcomes and monitoring drug therapy. Pharmacists' behavior varied the most in the following areas: ensuring that the prescription is legal, prioritization of medication management problems, and identification of drug-drug interactions.

CONCLUSIONS

Competencies were identified that need to be developed to improve pharmacist interventions in community settings. This study provides the first data on pharmacists' performance in Croatia and serves as a starting point for future studies and actions.

An electronic NAPLEX review program for longitudinal assessment of pharmacy students' knowledge

OBJECTIVES

To track pharmacy student knowledge over time using a proprietary software program in an accelerated program for curricular assessment.

METHODS

All students were required to complete a computerized comprehensive diagnostic examination 3 times during the doctor of pharmacy (PharmD) program: at the beginning of the second year, and near the end of the second and third years. The examination was comprised of 100 questions in 3 content areas: pharmacotherapy, preparation and dispensing of medications, and providing health care information. Within-subject differences in mean area and total percent scores were compared.

RESULTS

Based on 123 students' data, mean scores for pharmacotherapy and total percent scores for examination 1 were significantly different from examinations 2 and 3.

CONCLUSION

The computer-based comprehensive diagnostic examination shows promise for use as a component of a comprehensive assessment plan.

Global education implications of the foreign pharmacy graduate equivalency examination

Although the Foreign Pharmacy Graduate Equivalency Examination (FPGEE) is not intended to measure educational outcomes or institutional effectiveness, it may be a reliable and valid criterion to assess the quality or success of international pharmacy programs. This comprehensive review describes the evolution and historical milestones of the FPGEE, along with trends in structure, administration, and passing rates, and the impact of country of origin on participant performance. Similarities between the FPGEE and the Pharmacy Curriculum Outcomes Assessment (PCOA) are also explored. This paper aims to provide a global prospective and insight for foreign academic institutions into parameters for evaluating their students' educational capabilities.

Core competencies in natural health products for Canadian pharmacy students

OBJECTIVE

To reach consensus on core competency statements for natural health products (NHPs) for Canadian pharmacy students.

METHODS

Four rounds of a modified Delphi method were used to achieve consensus on core competency statements for NHPs. Pharmacy educators from Canada and the United States, and representatives from Canadian pharmacy organizations ranked their agreement using a 5-point Likert scale.

RESULTS

Consensus was achieved on 3 NHP-related core competency statements: (1) to incorporate NHP knowledge when providing pharmaceutical care; (2) to access and critically appraise NHP-related information sources; and (3) to provide appropriate education to patients and other health care providers on the effectiveness, potential adverse effects, and drug interactions of NHPs.

CONCLUSIONS

Consensus was reached among leaders in NHP education on 3 NHP-related core competency statements. Implementation of these competencies would ensure that graduating Canadian pharmacists would be able to fulfill their professional responsibilities related to NHPs.

Relationship between assessment item format and item performance characteristics

OBJECTIVE

To evaluate the relationship between assessment item formats (case-based versus noncase-based) and item performance characteristics.

METHODS

Assessment items (1,575) were collected from examinations administered in several therapeutics courses over 4 academic years. Items were categorized as either "case-based" or "noncase-based" and item performance characteristics (discrimination index and level of difficulty) were evaluated.

RESULTS

Noncase-based items represented approximately three-fourths of all items that were evaluated, and demonstrated a higher discrimination index than case-based items. Case-based items were generally lengthier and included more detailed information than noncase-based items; however, they were not more difficult and exhibited a lower discrimination index. Secondary analyses revealed that 5-foil multiple-choice items are more difficult and have a higher discrimination index compared to 4-foil items.

CONCLUSION

The format used for an examination/test item (case-based or noncase-based) has an impact on item performance characteristics.

Professional competences, credentialing and continuing professional development in the pharmacy profession - Model Framework for Patient Centered Pharmaceutical Care -

The crucial changes have taken place in the role of pharmacy profession in the past decade. All these changes have been systematically evolved and adopted to support professional quality improvement aspect. In general, the worldwide professional and national authorities have been committed to develop the professional competencies, credentialing and continuing professional development; to emphasis the maintenance of high standards of professional development and in response to changes which occurred to pharmacy education and national health regulation policy. The constantly evolving health regulatory environment in each country will shape the progress of this process in the future. This article provides a review of existing concepts for professional competences, credentialing and continuing professional development in pharmacy profession in an attempt to understand and clarify the complexity encountered in this comprehensive domain. It can also serve as a platform for the local interaction of a broad range of authorities in the health field.

Using item banks to construct measures of patient reported outcomes in clinical trials: investigator perceptions

BACKGROUND

Item response theory (IRT) promises more sensitive and efficient measurement of patient-reported outcomes (PROs) than traditional approaches; however, the selection and use of PRO measures from IRT-based item banks differ from current methods of using PRO measures.

PURPOSE

To anticipate barriers to the adoption of IRT item banks into clinical trials.

METHODS

We conducted semistructured telephone or in-person interviews with 42 clinical researchers who published results from clinical trials in the Journal of the American Medical Association, the New England Journal of Medicine, or other leading clinical journals from July 2005 through May 2006. Interviews included a brief tutorial on IRT item banks.

RESULTS

After the tutorial, 39 of 42 participants understood the novel products available from an IRT item bank, namely customized short forms and computerized adaptive testing. Most participants (38/42) thought that item banks could be useful in their clinical trials, but they mentioned several potential barriers to adoption, including economic and logistical constraints, concerns about whether item banks are better than current PRO measures, concerns about how to convince study personnel or statisticians to use item banks, concerns about FDA or sponsor acceptance, and the lack of availability of item banks validated in specific disease populations.

LIMITATIONS

Selection bias might have led to more positive responses to the concept of item banks in clinical trials.

CONCLUSIONS

Clinical investigators are open to a new method of PRO measurement offered in IRT item banks, but bank developers must address investigator and stakeholder concerns before widespread adoption can be expected.