Investigating the perceptions and behaviors that contribute to student preparation for the NAPLEX exam.

Introduction: The North American Pharmacist Licensure Examination (NAPLEX) is a critical assessment for pharmacy graduates. Declining first-time pass rates have led to increased focus on preparation strategies. This study evaluates a year-long NAPLEX preparation curriculum integrated into the fourth-year PharmD program, focusing on student perceptions, engagement, and performance.

Methods: A longitudinal, structured NAPLEX preparation curriculum was implemented for 151 fourth-year pharmacy students. The curriculum included mandatory assessments aligned with the NAPLEX blueprint and a self-directed study component using the UWorld Pharmacy RxPrep platform. Student engagement was quantified using a Usage Index derived from platform activity logs. A post-curriculum survey assessed students' perceptions of the program, which was analyzed using Principal Components Analysis (PCA).

Results: Variability in student engagement was observed, with the Usage Index showing a moderate correlation with performance on NAPLEX-style assessments. PCA identified four key components influencing students' NAPLEX preparation: Perceived Usefulness, Curriculum Effectiveness, Temporal Utilization, and Strategic Preparedness. Temporal Utilization was the only component strongly correlated with assessment outcomes, highlighting the importance of consistent resource use.

Discussion: Regular engagement with preparation resources was linked to better performance, though student perceptions of usefulness did not always align with exam performance. This highlights the complexity of preparing for high-stakes exams, where subjective evaluations of resources may not fully capture their effectiveness.

Conclusion: This study underscores the need for consistent engagement with preparation resources and highlights potential areas for improvement in NAPLEX preparation strategies. Future research should focus on strategies to improve student engagement and enhance self-assessment skills to better align perceptions with performance.