Development, implementation, and assessment of a tailored oral milestone remediation examination process for fourth-year pharmacy students

Performance assessments for student pharmacists are required by the Accreditation Council for Pharmacy Education to monitor student knowledge, retention, and professional skill sets. Near the end of their Advanced Pharmacy Practice Experiences (APPEs), fourth-year pharmacy students (P4s) at the University of Texas at Austin College of Pharmacy must pass a milestone exam (P4ME) to graduate. The P4ME contains four sections: adult medicine, ambulatory care, community, and hospital. If a student fails one or more sections of the initial multiple-choice P4ME, they must retake that specific section(s) on the makeup P4ME. If a student fails the makeup multiple-choice P4ME, they participate in a case based oral exam designed to determine whether they meet minimal competencies to pass the P4ME. This report outlines the process undertaken by the faculty to develop a high-stakes P4 milestone oral exam. While only a few students have participated in the process, outcomes differentiated P4s eligible for graduation versus those who needed to repeat an APPE. Lessons learned about the oral exam process include minimizing the number of faculty in attendance, shortening the exam duration, and standardizing the exam process. Positive aspects include remediation led by a subject matter expert and implementation of a unique rubric to assess student performance. Overall, the authors find the P4 oral milestone exam to be a feasible assessment tool for students who perform poorly on the initial and makeup multiple-choice P4MEs.