Calculation questions in the preregistration exam must be fair and reflect real-world practice

Over the past 20 years I have supported preregistration students, particularly with calculations in the preregistration exam. One advantage of the old multiple-choice question style was that the answer was given in the correct format with the correct units. In the new style of question, assistance is limited to a box in which to enter a number and the examinee is required to enter the correct units. I have been asked for help with these questions used for preregistration training — the questions, from various sources, were sent to me as images of printed papers or screenshots — with the following kinds of question having raised concerns:

• Questions that cannot be answered as there is insufficient information that cannot be claimed to be general knowledge;
• Questions that can be answered mathematically but would not be possible in real life; for example, where 2,000mL would be needed to provide 200mL of a solution;
• Questions that provide answers that would not be practical or acceptable in good clinical practice; for example, an infusion time of over 300 hours or sharing packs of medicine between old and young family members;
• Questions that provide answers that are incorrect owing to little consideration of pharmacy economics; for example, increased dispensing charges in one area but failing to account for any reduction in drug purchases;
• Questions that provide answers at several decimal places; answer boxes providing space for fewer decimal places; and ‘correct’ answers with even fewer decimal places;
• In rare instances, questions with answer boxes followed by the wrong units of measurement.

Clinical practice is not defined in absolutes and the preregistration exam does not allow individual answers to calculation questions to be assessed as anything other than absolutes. Providing a box for a numerical answer is insufficient; it does not allow individual answers to be interpreted and assessed, and it makes assumptions about the examinee’s skill set that may not be fair or true.

It may be that pharmacy practice, even at preregistration level, is now so varied that multiple-choice questions can no longer reflect universally applied principles. The question-setters themselves may not have a sufficiently varied background to appreciate how the information they provide in their questions can be applied in different ways in different settings — they may be limited to their own specialised areas of practice.

Students who sat the preregistration exam and complained about its content should at least expect that it will be independently assessed to ensure its suitability as a general entrance exam.

Roy Sinclair, former hospital pharmacist, community pharmacist and university lecturer