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Currents in Pharmacy Teaching and Learning 8 (2016) 827832

Research Article

http://www.pharmacyteaching.com

Knowledge retention of basic pharmaceutical sciences


in a PharmD program
Elizabeth J. Unni, PhDa,*, Manas Mandal, PhDb, Rajan Radhakrishnan, PhDc,
Erin Johanson, EdDa, Scott Stolte, PharmDb, Erik Jorvig, PhDa
a

Roseman University of Health Sciences College of Pharmacy, South Jordan, UT


Roseman University of Health Sciences College of Pharmacy, Henderson, NV
c
University of Charleston School of Pharmacy, Charleston, WV

Abstract
Objectives: To measure the retention of basic sciences knowledge in a PharmD program over a period of two years.
Methods: The study was conducted in two phases using assessment scores of the students. The rst phase measured the
whether basic science knowledge was retained over a period of two years using historical data. The aim of the second phase
was the same, but used a prospective study design. Additionally, the second phase also examined subject wise retention of
knowledge.
Results: The rst phase data analysis across all subjects showed a slight decay of knowledge over two years. The second phase
data analysis showed relatively small signicant knowledge gain across all subjects and moderately signicant knowledge gain
for biomedical sciences.
Conclusions: The results of the study demonstrate a varying level of retention of biomedical science s and pharmacology
knowledge over time. With the understanding that the graduating pharmacy students are not expected to retain or remember all
the knowledge they gained from the rst year of the program, these results demonstrate a satisfactory level of retention.
r 2016 Elsevier Inc. All rights reserved.

Keywords: Knowledge retention; Basic pharmaceutical sciences; Knowledge retention over time; End-of-year assessment

Introduction
Stobaeus philosophized What use is knowledge if there
is no understanding? Einstein, when opining the eld of
education, was quoted as saying knowledge must
continually be renewed by ceaseless effort, if it is not to
be lost.1 These great minds knew that knowledge was
something that was only as important as the comprehension
and retention it offered to students. Assessments of knowledge, both formative and summative, are a regular part of
* Corresponding author: Elizabeth J Unni, PhD, Roseman
University of Health Sciences College of Pharmacy, 10920 South
River Front Parkway, South Jordan, UT 84095.
E-mail: eunni@roseman.edu
http://dx.doi.org/10.1016/j.cptl.2016.08.018
1877-1297/r 2016 Elsevier Inc. All rights reserved.

academia. Yet, studies of knowledge retention are quite


limited and lacking in pharmacy education.
The purpose of pharmacy education is to ensure that
pharmacy students are competent to enter the profession and
have sufcient retention of knowledge to provide the best
medication therapy management possible for patients.
Pharmacists are required to gain an enormous and diverse
amount of knowledge during their professional training.
One pertinent question that can be asked in this context is
do pharmacy students retain the knowledge they gain in
early class years later in the program and afterwards when
they start practicing? Basic pharmaceutical and biomedical
science subjects are often taught in the earlier years of the
PharmD program, and with no empirical evidence students
and faculty often doubt the retention of that information

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E.J. Unni et al. / Currents in Pharmacy Teaching and Learning 8 (2016) 827832

later on. The basic science courses taught earlier in the


program form foundations on which clinical knowledge is
built. The clinical sciences are taught in the later years in the
program and are often reinforced during the nal year
clinical rotations. Also, clinical sciences often carry more
weight (~67%) in licensure examinations after graduation.
Literature has shown evidence of loss of retention of
basic science knowledge among medical students over
time.27 DEon2 reported knowledge loss among medical
students in immunology, neuroanatomy, and physiology
courses. Another study conducted among medical students
reported that performance in biochemistry and microbiology
in the basic sciences section declines by the time medical
students take the United States Medical Licensing Examination.3 Lazic et al.4 found that on basic sciences tests, fthyear medical students scored lower than second-year
students, but did better on clinical questions. Consistent
patterns of decline in knowledge retention of the basic
sciences were found by Swanson et al.5 Custers6 completed
a review of long-term retention of basic science knowledge
among medical students and reported that knowledge is
retained at two-thirds to three-fourths after one year and
decreases to below 50% retention in the following year of
medical education.
There is a lack of empirical evidence regarding the
retention of basic sciences knowledge in PharmD programs.
The aim of this study was to measure the retention of basic
sciences knowledge in a PharmD program. This study
objectively measured the knowledge retention of basic
pharmaceutical and biomedical science materials in pharmacy students over a period of three years.
Methods
The study was conducted at the Roseman University of
Health Sciences College of Pharmacy in the United States.
The college uses a block system of curricular design where
students learn one subject area at a time over the course of
the three-year PharmD program. Knowledge retention and
application leading to the development of critical thinking
is important in the college due to the focused, accelerated,
and non-longitudinal nature of the curriculum. Ideally,
students are expected to retain fundamental basic principles of a subject (block) that would be applied to
subsequent block material. The rst-year students are
taught biomedical sciences (biochemistry, medicinal
chemistry, immunology, and biostatistics), pharmaceutical
sciences (pharmaceutics, pharmacology, and pharmaceutical calculations), and social/administrative/behavioral sciences. The students are assessed every two weeks, adding
to 16 assessments in the rst year. The second-year
students are taught clinical sciences based on disease
states and take 16 assessments over the year. The thirdyear students have advanced pharmacy practice experience
(APPE) rotations. In addition to the regular assessments,

the students also take an end-of-year (EOY) assessment at


the end of each academic year.
The study was conducted in two phases using EOY
assessment scores of the students. The two phases measured
how well the students retained knowledge (gained/decayed/
remained the same) from all basic pharmaceutical and
biomedical science subjects over time utilizing historical data
and data from a prospective study design respectively. The
institutional review board exempt status was obtained from
the university following appropriate institutional guidelines.
Knowledge retention assessment tool
Students take the EOY comprehensive assessment at the
end of each academic year. The EOY assessments are
designed as an internal measure to assess the students
knowledge retained at the end of each academic year and
are used by didactic faculty to evaluate the effectiveness of
their teaching in the respective blocks. The EOY assessment
items are developed by the EOY assessment committee with
input and feedback from the faculty in respective areas with
expertise and the items are often written at the knowledge
level needed for an entry level pharmacist. The items are
often selected from the regular assessments based on the
item statistics and content validity. The basic science
material has six major content areas (medicinal chemistry,
biochemistry, pharmacology, pharmaceutics, social and
administrative sciences, immunology, and pharmaceutical
calculations) and 16 subtopic areas. The P1 EOY assessment is comprised of 100 questions covering all the basic
science material taught in the rst year. The P2 EOY
assessment is comprised of 150 questions, out of which 50
questions are from rst-year basic science material and the
remaining 100 questions are from second-year clinical
science material. At the end of third year, after clinical
rotations and prior to graduation, students take a capstone
assessment that contains 30 questions from rst-year basic
science and 70 questions from second-year clinical science.
Additionally, students have to pass the EOY assessments
(scoring at least 80%) to move to the next class, thus
providing them sufcient motivation to perform well on
these assessments.
Study design
The study was carried out in two phases. The objective
of phase I was to determine the retention of all basic
pharmaceutical and biomedical science material over a
period of one and two years using historical assessment
data. The retention of basic science course material learned
in P1 at the end of P1 and P2 years were determined. The
mean scores of the P1 EOY assessment and the mean score
of the 50 basic science items from the P2 EOY assessment
were calculated and converted into a 100-point score for
better comparison. One of the limitations in phase I was that

E.J. Unni et al. / Currents in Pharmacy Teaching and Learning 8 (2016) 827832

the assessment items used in P1 and P2 EOY assessments


were different, which could potentially lead to a difference
in item difculty between the years. Thus, the objective of
phase II was to determine the retention of all basic science
material over a period of one and two years using a
prospective study design. Hence, in this phase, the 50
questions for the P2 EOY basic pharmaceutical and
biomedical sciences section were chosen from the P1
EOY assessment that students took a year earlier.

Data analysis
Paired t-test was used to estimate if there was a
signicant difference between the P1 EOY score and P2
EOY score of the students. The signicance of the knowledge gain/decay was determined using the Cohens d effect
size. The internal consistency of each assessment was
determined using the KuderRichardson 20 (KR 20)
coefcient. Also, the item difculty (the proportion of
students who answered the item correctly) and item
discrimination (ability of an item to differentiate among
students on the basis of how well they know the material
being tested) for each assessment was determined. The item
difculty can range from 0.0 to 1.0; higher numbers indicate
more students answering the item correctly. The item
difculty for an assessment is the average item difculties
for all the items and the recommendation is between 60%
and 80% for an assessment with four-option multiple
choice. For item discrimination, the discrimination is
considered good if the index is above 0.30, fair if it is
between 0.10 and 0.30, and poor if it is below 0.10.
Subject-specic analyses were used to determine which
subjects were better retained by students at the end of
second year. The 50 questions in the P2 EOY assessment
that were based on P1 basic science materials were divided
into three sections: (1) biomedical sciences that included
biochemistry, medicinal chemistry, immunology, and biostatistics (20 questions); (2) pharmaceutics (11 questions);
and (3) pharmacology (15 questions). The remaining four
questions from social/administrative/behavioral sciences
were not included in this analysis.
In addition, a linear multiple regression analysis was
used to determine predictors of the P2 EOY basic science
score. The main independent variable was the P1 EOY
score and the analysis was controlled for gender, study time,
and study methods used by students. Students were asked
how long they prepared for the EOY assessment for the
study time variable (measured as no preparation, less than
two hours, two to ve hours, and more than ve hours) and
how they prepared for the EOY assessment for the study
method variable (measured as no preparation, prepared
using prior years EOY assessments, prepared using prior
regular assessments, or a combination of any of these
items). These questions were asked at the end of the P2
EOY assessment and data was collected anonymously. All

829

the analyses were done using SPSS 22 (SPSS Inc.,


Chicago, IL).
Results
Demographics
For phase I, class of 2014 data was used. The class size
was 136, the mean age was 26.4, and 46.2% were males.
For phase II, the class size was 138, the mean age was 27.2,
and 48.1% were males. The incoming overall GPA for both
classes was 3.4.
Phase I study used historical assessment score data to
determine the retention of all basic science material over a
period of two years (Table). To compare the retention of
material from the rst to second year, the assessment scores
from the class of 2014 (n 136) were used. The mean
score of the P1 EOY assessment was 81 (6) and the
corresponding P2 EOY mean score was 79 (8). The paired
t-test showed a statistically signicant difference between
the two scores (p o 0.01) and the Cohens d was 0.28. The
Pearson correlation between the two scores was signicant
(r 0.354; p 0.05).
The second phase used data from the class of 2015 (n
138) (Table). The P1 EOY score was 83 (7) and the
corresponding basic science score from the P2 EOY was 84
(7). There was no statistically signicant difference
between the two scores based on paired t-test and the
Cohens d was 0.14. The partial correlation coefcient after
controlling for the method of studying and the time spent on
studying was also signicantly strong at 0.613 (p o 0.05).
Subject-specic analysis (Table) revealed that biomedical
sciences (biochemistry, medicinal chemistry, immunology,
and biostatistics) had a signicant increase in knowledge
gain (Cohens d was 0.58). Though there was a gain in
pharmacology knowledge, the signicance was minimal
(p 0.07; Cohens d 0.19). Pharmaceutics showed moderate
knowledge decay from 83 to 78 (Cohens d was 0.45).
Linear multiple regression analysis found that the rst
year EOY assessment score signicantly predicted (regression coefcient 0.531; p o 0.01) the basic science score
in the P2 EOY assessment and explained 30.8% of the
variance in the model after controlling for gender, study
time, and study methods used by the students. The
descriptive analyses reported that while 40% of the class
did not do any preparation for the P2 EOY assessment, a
third of the class utilized at least some method of studying
such as working on the past assessments and spent less than
two hours in studying for the P2 EOY assessment.
Discussion
The main objective of this study was to determine
whether pharmacy students retain basic pharmaceutical
and biomedical science knowledge over time, and according
to our knowledge, this is the rst study in this regard in

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E.J. Unni et al. / Currents in Pharmacy Teaching and Learning 8 (2016) 827832

Table
Retention of basic pharmaceutical and biomedical sciences over time among PharmD studentsTable

Type of
assessment

Description of
assessment

Assessment
mean and
standard
deviation as %

Practical
Statistical
signicance
signicance (effect size by
(paired t-test) Cohens d)

Item difculty
(median and
Reliability 25th/75th
(KR 20)
percentile)

Phase Iclass of 2014 (n 136)


Used historical datathe assessment questions were not the same for the P1 EOY and P2 EOY assessments
P1 EOY
Learning retention 81 (6)
p o 0.01
0.28
0.70
86 (70/95)
at the end of
year 1 (100
items)
P2 EOY
Learning retention 79 (8)
0.78
80 (67/92)
at the end of
year 2 (50
items)
Phase IIclass of 2015 (n 138)
Prospective study designsame assessment questions used for P1 EOY and P2 EOY assessments
P1 EOY
Learning retention 83 (7)
p = 0.22
0.14
0.74
at the end of
year 1 (50
items)
P2 EOY
Learning retention 84 (7)
0.79
at the end of
year 2 (50
items)
P1 EOY
Learning retention 79 (9)
p o 0.01
0.58
0.70
biomedical
at the end of
sciences
year 1 (20
items)
Learning retention 84 (8)
0.72
P2 EOY
biomedical
at the end of
sciences
year 2 (20
items)
p o 0.01
0.45
0.77
P1 EOY
Learning retention 83 (11)
pharmaceutics
at the end of
year 1 (11
items)
0.76
P2 EOY
Learning retention 78 (11)
pharmaceutics
at the end of
year 2 (11
items)
P1 EOY
Learning retention 83 (11)
p 0.076
0.19
0.72
pharmacology
at the end of
year 1 (15
items)
P2 EOY
Learning retention 85 (10)
0.70
pharmacology
at the end of
year 2 (15
items)

academic pharmacy literature. Retention of basic pharmaceutical science knowledge is essential for developing apt
clinical skills in pharmacy students. According to the
Accreditation Council for Pharmacy Education (ACPE)
Standards 2016, The graduate must be able to develop,
integrate, and apply knowledge from the foundational
sciences (i.e., biomedical, pharmaceutical, social/

Item
discrimination
(median and 25th/
75th percentile)

0.17 (0.09/0.25)

0.17 (0.10/0.27)

86 (72/95)

0.17 (0.11/0.26)

88 (73/97)

0.18 (0.07/0.23)

80 (71/93)

0.14 (0.09/0.25)

91(73/96)

0.15 (0.01/0.21)

88 (70/96)

0.20 (0.10/0.25)

73 (69/97)

0.10 (0.07/0.21)

87 (72/96)

0.26 (0.15/0.28)

92 (81/97)

0.23 (0.14/0.26)

behavioral/administrative, and clinical sciences) to evaluate


the scientic literature, explain drug action, solve therapeutic problems, and advance population health and patientcentered care.8 To achieve this goal, integration of basic
pharmaceutical science courses with clinical science courses
has been recommended by several editorials and articles.9
13
A few studies based in medical schools have shown

E.J. Unni et al. / Currents in Pharmacy Teaching and Learning 8 (2016) 827832

evidence that an integrated curriculum can increase


basic science knowledge retention over time.1416 Though
there are arguments for and against curricular integration,
the fact still remains that there are several challenges in
implementing an integrated curriculum, and in the majority
of the pharmacy schools, the basic pharmaceutical courses
are taught in the beginning of pharmacy school and clinical
sciences towards the latter part of the program.11,1720
Similar to other health care programs such as medicine or
dentistry, the model of teaching the basic pharmaceutical
sciences and clinical sciences at two separate time periods
in the academic program leads to the question of knowledge
retention.
The current study is aimed at objectively measuring
basic pharmaceutical and biomedical science knowledge
retention by pharmacy students over a period of one and
two years using two phases. The rst phase that examined
the retention of knowledge for all basic science materials
(with similar, but non-identical assessments), demonstrated
a moderately signicant knowledge decay from 81 to 79
percentage points from the end of rst year to the end of
second year. However, though the difference is statistically
signicant, the academic signicance of the difference
cannot be conrmed without further studies. In the traditional grading system it takes a loss of at least ten
percentage points to cause a drop in letter grade. When
compared with the loss of knowledge in medical education
as reported by Custers6 in his review (approximately 50%
after two years), the loss of knowledge by less than two
percentage points after two years may be compatible with
the notion that there will be some degree of loss of
knowledge. When retention was examined using the same
assessment at the end of rst and second year in phase II,
the results showed an increase from 83 to 84 percentage
points for all the subjects together. Though the academic
signicance of this difference is unclear, the results are
pointing to the fact that there is at least no knowledge
decay. In addition, the only signicant predictor of the P2
EOY score on basic science material was the P1 score and
not how long they studied or how they studied. Subjectspecic analysis showed a knowledge gain for biomedical
sciences (biochemistry, medicinal chemistry, immunology,
and biostatistics), where the score increased from 79% to
84%. Pharmacology showed a knowledge gain, but not
signicant. Thus, the overall results of the current study
show satisfactory levels of retention of biomedical sciences
and pharmacology knowledge among pharmacy students
with accelerated block system of curriculum design.
The results from the current study are similar to previous
studies conducted among medical students which showed a
decline in basic science knowledge retention over time but
the magnitude of loss of knowledge is quite minimal in the
current study with pharmacy students.2,6 In fact, when the
data was collected prospectively, it showed knowledge
retention over one year and a substantial knowledge gain
for biomedical sciences. From a psychological perspective

831

of learning, transfer has to happen in learning.21 Transfer


is the ability to apply the concept learned in one context to
solve a problem in another context. When basic science
courses are taught in the beginning of the program without
context, content can often be forgotten later in the program.
Thus, efforts have to be made to create contexts and
emphasize relevance while teaching basic science so that
students retain it better.
The study is not without limitations. For phase I, the
assessments used for the original assessment and retention
assessment were different. However, the phase II was
designed to overcome this limitation. The study utilized a
cross sectional design and only measured the retention of
basic science knowledge in the form of memorization.
Further studies are needed to determine whether pharmacy
students can retrieve appropriate basic science knowledge
when faced with patient case scenarios.
Conclusions
The objective of the study was to measure the retention
of basic pharmaceutical and biomedical science knowledge
among pharmacy students over time. With the understanding that the graduating pharmacy students are not expected
to retain or remember all the knowledge they gained from
the rst year of the program, the results of this study show
compatible and varied levels of retention of biomedical
sciences and pharmacology knowledge and an incremental
learning in biomedical sciences in the studied student
population. Further studies are needed to determine whether
incorporation of clinical applications and/or curricular
integration of the basic and clinical pharmaceutical sciences
with repetition of the basic concepts will improve the
retention of basic science knowledge over time.
Conict of interest
None.
Acknowledgments
The authors acknowledge Dr. Tyler Rose for providing
thoughtful comments and feedback on the manuscript and
Michael Tanana for statistical analysis assistance.
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