Pharmacy Division Ramathibodi Hospital


News 10/08/2544

Good admissions decisions are essential for identifying successful students and good practitioners.

Zinc nasal spray has no effect on the duration of common cold symptoms and produces only a mild and transitory reduction in the severity of nasal symptoms.

Prepharmacy Predictors of Success in Pharmacy School: Grade Point Averages, Pharmacy College Admissions Test, Communication Abilities, and Critical Thinking Skills

David D. Allen, Ph.D., Department of Pharmaceutical Sciences; and C. A. Bond, Pharm.D., FASHP, FCCP, Department of Pharmacy Practice, School of Pharmacy, Texas Tech University Health Sciences Center-Amarillo, Amarillo, Texas.

[Pharmacotherapy 21(7):842-849, 2001. © 2001 Pharmacotherapy Publications, Inc.]


Good admissions decisions are essential for identifying successful students and good practitioners. Various parameters have been shown to have predictive power for academic success. Previous academic performance, the Pharmacy College Admissions Test (PCAT), and specific prepharmacy courses have been suggested as academic performance indicators. However, critical thinking abilities have not been evaluated. We evaluated the connection between academic success and each of the following predictive parameters: the California Critical Thinking Skills Test (CCTST) score, PCAT score, interview score, overall academic performance prior to admission at a pharmacy school, and performance in specific prepharmacy courses. We confirmed previous reports but demonstrated intriguing results in predicting practice-based skills. Critical thinking skills predict practice-based course success. Also, the CCTST and PCAT scores (Pearson correlation [pc]=0.448, p<0.001) were closely related in our students. The strongest predictors of practice-related courses and clerkship success were PCAT (pc=0.237, p<0.001) and CCTST (pc=0.201, p<0.001). These findings and other analyses suggest that PCAT may predict critical thinking skills in pharmacy practice courses and clerkships. Further study is needed to confirm this finding and determine which PCAT components predict critical thinking abilities.


One of the most important attributes of a successful clinician is the ability to think critically in patient care situations. Despite the recognition of the value of this ability for practice, there are no published reports of pharmacy schools having systematically evaluated this ability as part of their admissions process.

To date, 16 published reports have evaluated prepharmacy admissions criteria as predictors of academic performance.[1-16] Most of these studies were published in the late 1970s and early 1980s after the Pharmacy College Admissions Test (PCAT) became available in 1975. However, many of these studies occurred before the development of modern pharmacotherapy courses, problem-based learning courses, and clerkships. In addition, these studies primarily focused on academic success early in the pharmacy curriculum, as opposed to professional practice courses and clerkships, which more accurately imitate pharmacy practice.[1-8, 11, 13, 14, 16]

Prospective students are evaluated using various criteria for admission to pharmacy programs. There are differing prepharmacy requirements among pharmacy schools. These requirements focus mainly on biological and physical sciences, mathematics, and general education courses, such as writing, speech, and courses in the humanities and social sciences. Performance in these prepharmacy courses, as well as a student's overall grade point average (GPA), are important components of the admissions process at most schools. In addition, approximately one-half of pharmacy programs require applicants to take the PCAT. It is assumed that most, if not all, of these institutions use the PCAT as an admissions criteria; however, this has not been evaluated.

The PCAT was developed to assist admissions processes by providing more insight into the abilities of prospective students.[13] This test was altered in 1993 and currently is undergoing further revision. Performance on the test as a predictor of success was studied after its introduction in the 1970s and again in the mid-1990s. Most evaluations compared PCAT performance with academic performance in the first year of the pharmacy curriculum. There are conflicting reports about the predictive capabilities of this instrument.[3, 6, 12] A detailed review of earlier studies evaluating the PCAT and its utility as a success predictor, alone and in comparison with GPA, was published in 1995.[16] The authors of the review also evaluated the post-1993 version of the PCAT. While earlier studies demonstrated that the PCAT is a better predictor than GPA,[5, 12] other reports found the opposite result.[4, 9] The PCAT subsections were evaluated for predictive value as well.[3, 6, 9, 12]

In addition to PCAT and prepharmacy GPA scores, common prerequisite undergraduate courses have been assessed for predictive power. Math and science grades may be significant predictors of pharmacy school academic success; this suggests that performance in specific courses may be relevant to admission decisions.[7, 9] Certain demographic data may be important parameters as well.[15]

None of these studies focused on critical thinking skills or drug problem-solving skills, even though these skills are critical to the ability of today's graduates to provide pharmaceutical care for their patients. This study focuses on several new prepharmacy assessment measures -- the California Critical Thinking Skills Test (CCTST), the on-campus interview, and problem assessment scores -- as predictors of academic success in a modern curriculum. In addition, this study looks at various components within the professional curriculum, including grades for group- and problem-based learning courses and performance in nine categories of clerkships. This is the first study to focus on predictors of success for all components of the modern pharmacy curriculum.

Clearly, evaluation of predictors for success in a school of pharmacy (SOP) is needed to identify students who will matriculate these programs and achieve professional success. Newly established pharmacy programs have a significant disadvantage in predicting success due to lack of prior performance history in their curricula. The Texas Tech University Health Sciences Center SOP is a new school that graduated its first class in May 2000. Therefore, with a new curriculum, we evaluated predictors for academic success in our program. This work represents 4 years of data and will be continued as further data become available. It includes prepharmacy data, tests, assessments, and grades for all coursework in the SOP program, scored on a 0-100% basis.

Although limited to 4 years, the data show statistically significant factors for predicting success in our program. We found variables expected to predict for certain aspects of success in the program based on previous studies. In addition, we found new, unexpected results of a variable that predicts performance on clerkship rotations and in pharmacy practice courses. Though preliminary, this finding is very important, as it has not been previously demonstrated that a parameter can predict aspects of a curriculum most closely related to practice.


The Texas Tech University Health Sciences Center SOP admissions policy is similar to other pharmacy programs in the United States. Applicants are required to take the PCAT, submit transcripts from undergraduate institutions, complete a pharmacy experiential writing essay, have letters of recommendation submitted, and submit a completed application (along with an application fee). Based on these requirements, students are invited for an on-campus interview. During the interviews, students are required to take the CCTST, complete a writing sample, participate in a group patient problem-solving session, and undergo interviews by faculty, staff, and students. A tour of our new state-of-the-art facility is given, and each applicant's computer skills are evaluated. The computer assessment is not used for admissions decisions, but it gives applicants an idea of their baseline computer abilities. It also identifies skills that need to be obtained for the curriculum (all course materials are Web based and require computer skills to access). The computer evaluation results are provided only to students who are admitted. All of the interview parameters are scored and then combined into a final interview score, which is used for the final admissions decision.

Using interview components, the PCAT, the CCTST, recommendations, transcripts, and other relevant information, admissions decisions are made. Our study made use of this information in assessing the predictive value of various factors involved in admission decisions. Data were collected and used for the predictor and course grouping variables described below. Data were entered into Microsoft Excel worksheets. After completely entered for a school cycle, the data were read into an SPSS file and evaluated for statistical significance. The predictor variables evaluated were as follows:

These predictor variables were compared with student performance in course group categories. It should be noted that Texas Tech University does not use letter grades for final evaluation, but rather the actual percentage obtained. Thus, GPA as defined below is the average of the student's percentages of the courses grouped together (0-100%). The course categories used for comparison with predictor variables were defined as follows:

A full listing of individual courses by the above categories is provided in Table 1. The n values for these course groupings ranged from 230-269, with most values in the upper part of this range. The sole exception to this n range was the PHARMACOT course grouping, which had an n value of 169.

Statistical Analysis

Data were evaluated for differences by simple regression analysis, using the statistics program SPSS (SPSS, Inc., Chicago, Illinois). Predictor variables were compared with each student's percentage average (as described above) for the individual course groupings. Regression analysis of predictor variables for student percentage grades allows for more robust analysis of these parameters than would be possible if letter grades corresponding to a number (A = 4.0, B = 3.0, etc.) were assigned. The a priori level of significance was set at a p value less than 0.05.


Using simple regression analysis, predictors for academic success were compared with course groupings and overall grades for the first professional year and each student's overall SOP grades. Results of the full regression analyses with correlation coefficients and p values are provided in Table 2. Significant predictors for success in the program were CCTST, PreP-GPA, OVERALL-GPA, INTERVIEW, and PCAT. PreP-GPA and OVERALL-GPA were the most robust predictors of success in the SOP professional program; their significance was evident in all categories evaluated. The PCAT was the third best predictor, showing significance in seven of eight categories. The INTERVIEW was predictive in three categories and CCTST in two categories. The ORGANIC 2 vs 4 showed no significant prediction ability in the course groupings we evaluated; this variable is therefore not presented in Table 2. Based on strengths of association, the overall PreP-GPA was the best predictor of success (Pearson correlations [pc]<0.300) for the eight categories in Table 2. The ORGANIC 2 vs 4 was the only category that failed to prove significance (data not shown). The only course grouping for which overall prepharmacy GPA was not the best predictor of success was the PRACNCLK courses.

The PCAT, widely viewed as a predictor of performance in the first professional year (the year after 2 years of prepharmacy coursework), was a significant predictor in seven of nine categories evaluated. The INTERVIEW score proved a significant predictor in three of nine categories. Critical thinking skills as a predictor of success in a pharmacy curriculum had not been evaluated before our study. It seems reasonable that higher critical thinking skills would relate to better ability of the student to assimilate information for problem solving necessary for success in pharmacy practice and clerkship courses. Thus, the finding of CCTST as a significant predictor for pharmacy practice and clerkship courses is not surprising. The CCTST predicted significantly for MGMTBEHAV and PRACNCLK course groupings. In addition, CCTST approached significance for predicting CRSWTEAM performance.

The best predictors for the first professional year were OVERALL-GPA (pc=0.380, p<0.001), PreP-GPA (pc=0.357, p<0.001), and PCAT (pc=0.199, p<0.001) (Table 2). Overall SOP GPA was best predicted by OVERALL-GPA (pc= 0.52, p<0.001), PreP-GPA (pc=0.299, p<0.001), and PCAT (pc=0.224, p<0.001). Biomedical science courses were best predicted by OVERALL-GPA (pc=0.316, p<0.001), PreP-GPA (pc=0.277, p<0.001), and PCAT (pc=0.126, p=0.04). The best predictors for pharmaceutical science courses were OVERALL-GPA (pc=0.353, p<0.001), PreP-GPA (pc=0.303, p<0.001), and PCAT (pc=0.171, p=0.005). The previous five groups all show the same three predictors in the same order of strength (OVERALL-GPA, PreP-GPA, and PCAT). This consistent finding suggests these course groups are similar in structure, delivery, and evaluation to pre-pharmacy courses at our SOP. Management and behavioral courses were best predicted by OVERALL-GPA (pc=0.330, p<0.001), PreP-GPA (pc=0.231, p<0.001), and CCTST (pc=0.166, p=0.011). The best predictors for pharmacotherapy courses were OVERALL-GPA (pc=0.369, p<0.001) and PreP-GPA (pc=0.367, p<0.001). In contrast, the best predictors for courses with teams were OVERALL-GPA (pc=0.306, p<0.001), PreP-GPA (pc=0.292, p<0.001), PCAT (pc=0.191, p=0.002), and INTERVIEW (pc=0.132, p=0.035). The best predictors for pharmacy practice and clerkship courses were PCAT (pc=0.237, p<0.001), CCTST (pc=0.201, p=0.001), INTERVIEW (pc=0.188, p=0.002), OVERALL-GPA (pc=0.183, p=0.003), and PreP-GPA (pc=0.145, p=0.017). The pharmacy practice and clerkship courses were the only groups in which all five prepharmacy predictors had statistically significant associations.

One aspect of the regression analyses involving the CCTST and the MGMTBEHAV course groups was particularly interesting. We found that CCTST significantly predicts the student's score on the PCAT exam (pc=0.448, p<0.001). The CCTST was the best predictor of success on the PCAT (the converse was also true). In addition, we found overlap between the confidence intervals for the regression analysis between the CCTST/PCAT and MGMTBEHAV and CCTST/PCAT and the PRACNCLK courses. To test the hypothesis that the CCTST and PCAT may be measuring the same ability, we did additional regression analyses on student grades in over 20 combinations of course groups and randomly selected combinations of individual courses to determine how the CCTST and PCAT varied. In all regressions, the CCTST and PCAT varied in the same direction and magnitude.


One of the most difficult functions of a SOP admissions committee is deciding which applicants should be admitted to the school's professional degree program. These students will matriculate through the curriculum and, more critically, enter the profession. These decisions have bedeviled admissions committees since the first entrance standards for pharmacy schools were developed. Because of increasing numbers of applications, most pharmacy schools rely on easy-to-obtain data and standardized assessment tests to make their admissions decisions. An important evaluation is that of the ability of a prospective student to think critically when conducting patient care. This report is the first to evaluate this ability systematically in prospective students.

Accurate predictors of academic success are critical to identifying applicants who will not only succeed as students but who will also develop into good practitioners. Predictors of success in our pharmacy curriculum are the major focus of this work. Several studies evaluated parameters used for determining which students will succeed. However, the ability to predict student performance in experiential situations, such as clerkships and pharmacy practice courses, has been lacking. Prediction of these abilities offers insight into an applicant's potential as a practitioner. We confirm previous findings pertaining to the value of GPA and PCAT scores as academic success predictors. We also demonstrate that our interview process predicts student performance in three categories of courses: MGMTBEHAV, CRSWTEAM and PRACNCLK. These course groupings require communication skills, which appear to be evaluated in our interview process. It seems that our interview process allows prediction of success in courses where these skills are necessary. We also found that critical thinking skills are predictive of student performance in clerkships and pharmacy practice courses. Clearly, the ability to identify students who will perform well in these courses suggests a likelihood of predicting potential pharmacy practice abilities. The CCTST predicts performance in the MGMTBEHA and PRACNCLK course groupings. Whereas the PreP-GPA and OVERALL-GPA have predictive value for PRACNCLK courses, the CCTST and PCAT have stronger predictive value for these course groups. This is the first study to find a significant predictor for these courses, which demonstrate practice-based abilities and pharmacy student performance in the later stages of pharmacy curricula.

The CCTST has been in existence since 1990. It correlates well with standardized scores, including the Scholastic Aptitude Test and its components.[17] Accordingly, it is not surprising that the CCTST predicts a student's score on the PCAT (pc=0.448, p<0.001). Our additional findings with confidence intervals for the CCTST and PCAT with regard to the PRACNCLK and MGMTBEHAV course groups, in addition to the regression analysis with more than 20 randomly selected course groupings, strongly suggest that these tests may be measuring the same ability: critical thinking. Although additional study is needed to confirm this finding with a more diverse student population, this is potentially very important. The PCAT may contain elements that evaluate critical thinking. Additional study is needed to elucidate which components of this test may be useful in assessing critical thinking. This result confirms previous evaluations that identify the CCTST as a predictor of students' ability to perform on the Graduate Record Examination.[18]

Numerous pharmacy schools are evaluating the critical thinking skills of prospective students. We are aware of six schools using the CCTST, while as many as three other schools are using the Watson-Glaser Critical Thinking Skills Assessment. The academic community is clearly interested in improving its abilities to predict both the academic performance of students and the potential of future pharmacists to function successfully in practice.

At the Texas Tech University Health Sciences Center SOP, we have been using the CCTST in our evaluation of applicants since the beginning of our program (4 years). We have held a strong belief, which seems to be embraced by other members of the academy, that critical thinking skills are a very important aspect of an applicant's portfolio for admission. While this may be a very reasonable view, without supporting data such a concept would be frivolous. We provide justification for continuing the consideration of applicants' critical thinking skills. In addition, we also offer evidence suggesting that the PCAT is a reasonably good measure of critical thinking skills. It should be noted that the American Association of Colleges of Pharmacy PCAT advisory committee is considering adding critical thinking and writing skills components to the admissions test. Although it appears now that these proposed ideas will be acted on, the exam must be piloted and validated before these components can be added. One advantage of the CCTST is that it is already validated. Our results provide evidence that it offers insights into potential performance of applicants in clerkship and pharmacy practice situations. It also has predictive value for the Graduate Record Examination, as noted above. Until such time that the critical thinking component of the PCAT is delineated, the CCTST may be a good alternative. The PCAT appears to be a fairly good predictor of critical thinking skills for our students, but this finding needs to be scientifically validated in a much larger and more diverse group of pharmacy students.

The CCTST tests the five target cognitive skills identified in a Delphi Report compiled by one of the CCTST's authors.[19] The Delphi Report developed an expert consensus on critical thinking for educational assessment and instruction. The cognitive skills tested by the CCTST are interpretation, analysis, evaluation, explanation, and inference. The test was developed to assess the critical thinking skills of undergraduate college students in relation to general education requirements for the baccalaureate degree.[20] The test's content validity and experimental validation were based on four experiments conducted at California State University, Fullerton.[21] Further evaluation of this instrument, including factors predictive of critical thinking skills; effect of ethnicity, major, and critical thinking esteem (one's view of one's critical thinking abilities); and interpretation of group norms and subscores have also accomplished.[22, 23] This particular critical thinking skills assessment test is gaining in popularity; given the more recent nature of the examination compared with other instruments, this is likely to continue.

Pharmacy is not the first health care profession to evaluate critical thinking skills. The nursing profession both evaluates and teaches critical thinking skills.[24] Significant correlations have been shown between CCTST scores and a number of academic success indicators, including GPA and standardized test scores. Strengths in critical thinking skills have been noted in institutions where faculty participate in discussions about critical thinking and impose curricular changes to enhance students' critical thinking skills. Thus, the idea that the culture of an institution must change to advance critical thinking skills seems warranted. Clearly, successful application of critical thinking skill evaluation to another health care field that, as with our own profession, requires these types of abilities to be used on a day-to-day basis provides even further justification for assessing these skills.


Since this is the first published report evaluating measures of critical thinking for pharmacy students, this study will need to replicated in other SOPs. In addition, since some of the results of this study involve fourth-year clerkships taught for the first time, we will need to repeat this study in several years, after the pharmacy practice faculty develop better and more consistent measures of clerkship performance. As more data become available in future years, it is possible that associations and correlations may change (our findings are based on only 1 year's worth of data for fourth-year clerkships and 4 years of data for first-year courses).


Instruments to evaluate critical thinking skills may offer insights into students' future performance in pharmacy practice and practice-based clerkship courses. Critical thinking abilities are likely to predict practice abilities, as these course groups are closely related to professional pharmacy practice. The PCAT and CCTST are very closely related in our student population and may predict similar abilities. Although further study is needed to confirm these results and these predictor instruments, PCAT or a component of the PCAT exam may predict critical thinking skills and abilities.

Table 1. Doctor of Pharmacy Courses in Each Predictor Category by Year and Semester Credit

Course Categories First Year (no. of credits) Second Year (no. of credits) Third Year (no. of credits) Fourth Year (no. of credits)
Biomedical Immunology (3)
Anatomy and Histology (5)
Principles of Disease (2)
Physiology (5)
Pharmaceutical sciences Drug Delivery Systems I (3)
Drug Delivery Systems II (3)
Biochemistry (5)
Principles of Drug Action (3)
Drug Delivery Systems III (2)
Clinical Pharmacokinetics (3)
Management, behavioral Behavioral Sciences (2)
Personnel Management (2)
Law (2)
Practice Management Selective (2)
Financial Management (2)  
Clerkship, practice Orientation to Practice (3)
Drug Information Clerkship (1)
Drug Literature Evaluation (2)
Pharmaceutical Care I (3)
Pharmaceutical Care II (4)
Parenteral (1)
Community Pharmacy Clerkship (3)
Physical Assessment (2)
Current Topics (1)
Hospital clerkship (2)
Ambulatory Care clinical skills clerkship (2)
Inpatient Care clinical skills clerkship (2)
Grand Rounds (6)
Adult Medicine clerkship (6)
Pediatrics clerkship (6)
Geriatrics clerkship (6)
Primary care clerkship (6)
Rural clerkship (6)
Selective Hospital, Community clerkship (4)
Elective clerkship (6)
Pharmacotherapy   Blood and Reticuloendothelium (1)
Cardiovascular (3)
Infectious Disease (3)
Endocrine (2)
Reproductive (1)
Renal (2)
Gastrointestinal and Hepatic (2)
Respiratory (2)
Integumentary (1)
Musculoskeletal (1)
Neurosensory (2)
Psychiatry (2)
Nutrition (1)
Oncology (2)
Special Populations (1)
Pharmacogenetics (1)
Clinical Toxicology (2)
Team, group Community Action Project (1) Case Studies I (3) Case Studies II (4)
Case Studies III (4)

Table 2. Predictors of Success in the School of Pharmacy Curriculum

Predictor Pearson
CCTST score Significant 0.048 0.086 0.008 -0.011 0.166a 0.015 0.113 0.201b
(2-tailed) 0.433 0.184 0.894 0.855 0.011 0.849 0.067 0.001
PreP-GPA score Significant 0.357b 0.299b 0.277b 0.303b 0.231b 0.367b 0.292b 0.145a
(2-tailed) 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.017
OVERALL-GPA score Significant 0.380b 0.352b 0.316b 0.353b 0.330b 0.369b 0.306b 0.183b
(2-tailed) 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.003
PCAT score Significant 0.199b 0.224b 0.126a 0.171b 0.218b 0.133 0.191b 0.237b
(2-tailed) 0.001 0.000 0.040 0.005 0.001 0.086 0.002 0.000
INTERVIEW score Significant 0.091 0.119 0.060 0.077 0.271b 0.118 0.132a 0.188b
(2-tailed) 0.146 0.072 0.339 0.219 0.000 0.138 0.035 0.002

aCorrelation is significant at the 0.05 level (2-tailed).
bCorrelation is significant at the 0.01 level (2-tailed).


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Zinc Nasal Spray Has No Effect on Duration of Common Cold

WESTPORT, CT (Reuters Health) Aug 03 - Zinc nasal spray has no effect on the duration of common cold symptoms and produces only a mild and transitory reduction in the severity of nasal symptoms, according to the results of a randomized study published in the August issue of the American Journal of Medicine on Friday.

"There is no strong and consistent convincing evidence that zinc has any major impact on a cold," Dr. Edward A. Belongia from the Marshfield Medical Research Foundation, Marshfield, Wisconsin, told Reuters Health. However, Dr. Belongia added that in their trial they did not use the same product that is on the market. That product (Zicam; Gel Tech, LLC, Woodland Hills, California) uses a much higher concentration of zinc in a different compound, he noted.

Dr. Belongia and colleagues randomly assigned 160 patients with acute upper respiratory illness to receive zinc nasal spray containing 0.12% zinc sulfate or placebo. The subjects were told to administer two inhalations into each nostril four times a day, for up to 14 days, until their symptoms resolved. The researchers found that for both the active-treatment group and the placebo group there was no significant difference in time to symptom resolution (p = 0.45), with a median time to symptom resolution of 7 days. Although the severity of symptoms was lower in the zinc group compared with the placebo group, the difference was only significant for day 0, 1 and 2 of treatment. Dr. Belongia's team also notes that patients in the zinc group had lower mean symptom scores at baseline compared with those receiving placebo (p = 0.08).

"I do not think that any zinc formulation has a benefit," Dr. Belongia said. "I think zinc as cold remedy is probably on its way out." Dr. Charles Hensley, from Gel Tech, told Reuters Health that he does not question the findings reported by Belongia et al. "Spraying zinc directly into the nostril is ineffective, which is why our delivery system is very different than that used in this study," he said.

In addition to a dose of zinc that is more than twice as high as the one used in this study, Gel Tech suspends the zinc in a gel that coats the nasal mucosa allowing the zinc to remain in contact with the mucosa for up to 30 minutes. It is this combination that produces the beneficial effect of Zicam, Dr. Hensley explained.

Dr. Belongia remains doubtful, however. What has been published in the medical literature in support of Gel Tech's claim could be stronger, Dr. Belongia said. Despite the difference in the concentration of zinc and the way it is delivered, he believes that the usefulness of zinc in shortening the duration of the common cold remains unproven.

Am J Med 2001;111:103-108.

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