The Naplex®: My opinion....

Tuesday 15th October 2009 I went to bed just after midnight and set my alarm for 4.30am to squeeze in a few extra hours of last minute cramming before the exam, as I hadn't quite finished reading all the scraps of paper and books and notes and websites and links and downloads that I had wanted to get through before I sat the exam. In the end I just couldn't wake up that early and re-set my alarm for 7am instead. Before I went to bed I had made sure all my documents were at hand - my US drivers license, my UK passport and my US Social Security Card - all with the exact and precise same version of my name in. I also had the address stored in my Sat Nav, and my clothes laid out for what I had been forewarned would be a somewhat cool room temperature. 7am and I wake up, get ready and go. The exam was due to start at 8am, but the paperwork said you had to be there 30 minutes before to go through the necessary checks. The place was a bit tricky to find, but as I walked towards the block a couple of other exam takers (not for pharmacy) were walking in the same direction, so I just followed them. Otherwise I would probably have never found the place, so take the phone number of the exam facility with you just in case! In the room there were different requirements depending on which exam you were taking. For Naplex takers you get a piece of paper to read with the rules on and then have your FINGER PRINT taken and then a photo. Other exam takers had to give PALM PRINTS, which apparently reads the veins in your palm, which is pretty clever, but we don't have to do that currently. You will be given a locker to put all your personal belongings in, so you are OK to take a wallet, cell phone and so on into the building, somewhat unlike the FPGEE. One by one (as each person may have slightly different rules to listen to) you are taken in to the exam area. A different person explains more rules, asks you to double check all your pockets, explains the option for a 10 minute break after 2 hours, and again takes your finger print. Then you get a small wipe-out board and a felt-tip pen to write on it - careful here because you must NOT rub what you write out! If you fill the board put your hand up and they will give you another one. The examiner said that I could put on the earphones if I wanted as other people in the room would be speaking at some points (maybe they were taking the dreaded TOEFL?) or I could use the ear-plugs he gave me. I tried the ear plugs and they were useless, so I put on the ear-phones and that kept me focused as I didn't notice anyone speaking the whole time. Before the exam starts there is an optional practice program to help you get familiar with the buttons. I suggest you do this as it was useful. Oh, and the examiner, proctor, whatever his title is asked if I wanted a calculator (there is one on the computer that appears by pressing a button) but I recommend 100% that you take the calculator or ask for one, as the computer version just doesn't feel as good as one in your hand, and I think I was probably much faster with the hand held one. Finally, at almost exactly 8am to the dot, I hit the "start exam" button. In the exam rules I had read in the ante-room it had said you may not write on the white-board until the exam starts, so as soon as the clock was running the first thing I did was to write down the four or five formula I had chosen to try and remember. May be it was nerves, but I only remembered three, and couldn't for the life of me remember what the other two were even about. Oh well. Now, someone I know once told me the Naplex was easy. He lied. If he had said that there was plenty of time to do all the questions, that would have been true. I never ever rushed, I spent a long time just sitting in thought trying to decide which answer was best, I never once looked at the clock, and I finished with 13 minutes to spare. I was quite surprised when a box sprang up after 2 hours asking me if I wanted to take the optional 10 minute break - which I did, and I will mention more of that in a minute. But time-wise, there was plenty of time as far as I was concerned. If that person had said that a lot of the maths questions were very simple and straightfowards, that would have been correct too - many were very very simple. But when he said that the exam itself was easy he was definitely lying - it was NOT EASY! Before the exam I had tried to sit the online pre-Naplex which costs $50 and is available on the NABP website. It just so happens that the one time I tried to take it (admittedly a little late, as I was only trying to do it the night before the exam!) there was some glitch with the server so I couldn't take it. That means I can't comment on how close it was to reality, or how well that score would have matched my score from the real exam, but anyway, I would probably advise you to spend the $50 as all other sites that I have looked at asked many useful questions, but none quite matched what I experienced in the actual exam. There was one site I used - called exam master - which was a bit expensive at $99 for a months usage - but it had thousands of good questions, and I will keep using that site for practice until my membership expires. One of the options on that site is to select up to 150 questions and sit it in an exam style experience - the other option is to call it a tutorial, where you get the same multi-choice question but then you can hit the "explain" button, and it will give the logic for the right and wrong answers. I had only chosen to pay this $99 membership because my pre-Naplex didn't work, but I had one days usage before I sat, and I gave myself a 150 questions exam to practice on. My score was about 60% on that site, and the way its broken down you can see you get, for example, 90 correct answers and 60 wrong. This gave me the idea that in the actual exam I would have two columns, one for "certain I got right" and another for "not sure" and I would aim to have more in the first column than in the second! I actually did this, although it wasn't perfectly exact as you can't be certain you've got anything right really, but in the end I had three columns, as I amended "not sure" to "good/best guess" and another column for "absolutely no flipping idea". At the end of the exam my three columns were: Confidant:Good guess:no idea - 76:81:16 = 173 total. The exam has 185 questions, so I guess I must have forgotten to mark my answers sometimes. Now I'm going to make an assumption that 90% of the time I was confidant I was right, and 40% of the time I was making a good guess (ie it was probably down to one of two likely answers) I was right, and I'll assume my complete guess was right 20% of the time, and the missing 12 answers I'll let them be all wrong although they probably were all completely correct of course :-) So adding that all up, I'm going to guesstimate (and I feel that this is the lowest I could have got), that I got: 76x(95/100)+ 81x(40/100) + 16x(20/100) = 72+32+3=107/185=58% - nope, I'm going to add 3 bonus percent from those missing answer, so I've decided that the lowest mark I could have got is 61% in the Naplex. If it just so happens that the scaled score reflects a pass mark of 60% then my scaled score should be about 76 or 77 - ie I've just just just scraped a pass. Of course if I find I didn't pass, then I'll be able to estimate whether I think the actual pass % is 70% or 75% etc, or if I passed with a big margin, then I'll be able to calculate the actual pass % is 55% or even 50% etc - we shall see. Bottom line, for me, is I do not feel confidant, but I do think I might have just scraped a pass. Ok, so here's the bit everyone wants to know of course! What came up in the test? Well, firstly, it was nothing at all like what I was expecting. I don't know why, and I'm not even sure what I was expecting, but all the questions seemed to me to fall in to one of three categories: 1. Mathematical questions: As I said earlier, a lot of these were really simple. How simple. Let me make a question up: You want to make a mixture that has 5% of drug Z in. You have some capsules which each contain 1gm of drug z. How many capsules would you need to make 100gm of the mixture. If you can't do those sort of questions, then you're in trouble! I'm not sure, but I'd swear I had 15 questions like that! 2. Pure clinical with a twist of nasty: I feel like every question that was on the test was asked in a tricky way. Hardly any clinical question was straightforward, and a couple of them I wasn't exactly sure what they meant in the question. (After the exam there is a short survey and a feedback opportunity, so if you get any questions you couldn't make sense of make a note and you can write a comment about them there. I remembered one question which I commented on in that feedback box, but there was at least another one I should have added there too). You want an example of course, so here's a question I shall make up as an example. Let's say you know what drug x is. Of course you do, you're very clever! Well, they don't ask you what drug x is, or what it is for or how it works, they give a list of 5 other drugs, 2 of which you've never heard of, and ask which of these 5 is NOT for the same use as drug x. Nasty nasty nasty. Another thing they did, and they kept doing this, is they gave a lovely long clinical profile chart, with a patient taking 8 meds you know and are familiar with. Then they say, which one would you stop. Hmmm. Nasty. Then they say if you stopped x (which may or may not be your previous answer), which of the following 5 drugs (2 of which you've never heard of) would you replace it with? Nasty nasty nasty. 3. Odd facts you either know or don't have a flipping clue about: OK, there were loads of nice simple questions along the lines of what is the OTC medication "brand z" for, which of the following is for disease y, and if a patient has the following symptoms which of these 5 medicines would you recommend. Those were all very nice, and generally went in my "confidant" column. However, I must have been asked 4 or 5 times which reference book would you use to look up such and such a problem in, and at least 3 of the five options I had never heard of. Nasty. And quite a few times they asked about drugs I just hadn't heard of, and although you can sometimes rule them out because you know it is one of the others, sometimes you aren't sure, and so I ticked the unknown drug just because (that would be in the "no flipping clue" column). And finally, here's a horrible horrible amazing and horrible thing for a multiple choice exam - twice I was asked to calculate a problem and then give my answer in the box. No multiple choice options at all. Just work it out and write my answer in the box. I can only hope that is how they test the test questions, because it sure aint multiple choice. So, what would I do different in terms of study, knowing what I know now? Well, I think I'll try and re-read APhA (still the best source, but get the latest edition don't accept an old out-of-date version) and focus a lot more on what NOT to give, and what ELSE if you can't give the first choice. For maths i'd just double check a couple of formula's that I may have needed (they are almost all in the front pages of the Manan Shroff's "reference guide for pharmaceutical calculations" book. none of them are at all difficult. I shall search high and low for a list of reference books and find out what they are useful for, and I shall perhaps try and get more familiar with any new drugs that came out over the last two years, as I am sure all the drugs I had never heard of must have been new releases. Just to finish off one matter I mentioned earlier - the 10 minute break. Strangely, but don't hold me to this as it may be different where you take it, you can leave the building during those 10 minutes. I could have gone to my car, flicked through and found those two bloody formula I had forgotten, and gone back in all very happy. As it happens I just used the restroom and went back in, but it does make you think. I should also add that if I had looked at any paperwork for more info it wouldn't have made any difference for me, as I never got any of those sorts of questions in the second half of my test. But I'm just mentioning it in case you are a serious chain smoker or you spotted a Starbucks next door, or want to eat something at the 2-hour break. You can. As a final word of caution, I must remind you that the exam is an adaptive test, and asks questions based (somehow) on how you answer each question. There must be a large pool of questions to draw from (someone once mentioned 60,000 but who knows) and I am sure someone else taking the same test today will have a completely different experience and totally different moans and complaints, so don't assume that just because all my math questions seemed fairly easy (they weren't, I've just mentally blocked out the difficult questions so I can sleep at night), it doesn't mean you won't be stuck with a whole pile of nasty questions about (enter subject you find most horrendous!). Well, I have no idea when the results will come through, but I shall of course report it all here as soon as I know. But for the time being I must now focus on the CPJE and will add that update shortly after I sit the exam next Monday. Good luck to everyone, you're going to need it!! Farmacyst