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Examining Tier 2 vocabulary in pharmacy assessments: Implications for inclusive design
Elisa Greene1, Jamie Adam1, Amanda Nelms1
1Belmont University, 1900 Belmont Blvd, Nashville, TN 37212, United States of America.
Introduction:
Pharmacy exams are often written by course faculty, with vocabulary influenced by the individuals' context. Faculty-developed pharmacy exams often include Tier 2 vocabulary-words with multiple meanings-that may challenge multilingual learners (MLs) and students with lower reading comprehension. Unlike standardized assessments such as the North American Pharmacist Licensure Examination (NAPLEX), faculty-written items may introduce linguistic variability, potentially impacting equity in assessment.
Methods:
Exam questions from eight courses in a private Doctor of Pharmacy (PharmD) program were analyzed using NVivo for word frequency and thematic coding. A total of 2195 faculty-developed questions and 225 NAPLEX-style review questions were examined. Words were categorized into Tier 1 (basic), Tier 2 (multi-context), and Tier 3 (discipline-specific) using open coding and AI-assisted thematic analysis.
Results:
Thirty of the 75 most frequent words (40%) in faculty exams were Tier 2. Themes with the highest Tier 2 presence included Treatment & Therapy and Pharmacy Concepts. Words such as risk, treatment, and appropriate demonstrated semantic variability across contexts.
Discussion:
Frequent Tier 2 vocabulary in faculty exams may inadvertently assess language proficiency alongside course content, posing barriers for MLs and students with lower reading comprehension. These findings align with literature on language equity in health professions education and underscore the need for faculty development in item writing.
Conclusion:
Incorporating vocabulary review tools, glossaries, and Universal Design for Learning principles may reduce linguistic barriers and improve exam validity. Future research should explore correlations between Tier 2 word frequency and student performance across diverse programs.
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