However, assessing students’ dosing knowledge is not straightforward. Asking students to memorize specific dosing, which can lead to medication errors, particularly in special populations (e.g. paediatrics, geriatrics) may not be optimal. While it is necessary to ask students which reputable source they used to identify correct doses, these items may be better served in another course (i.e. drug information). Also, given that most students will practice in a general retail or hospital staff setting, looking up every dose is not efficient given they will be entering,

reviewing and verifying numerous orders and medications per hour. Therefore, dosing UK-371804 items which contain dosing ranges may be better suited in providing a balance for students in understanding if the

dose is within the correct range and to look up any medication that draws a red flag (e.g. dosing outside the range). Overall, the strengths of the study are multi-fold. This is the first study to specifically evaluate dosing items in pharmacy TP courses and the first to simultaneously evaluate format and content. It also provides additional data on Case-based items and their ability to discriminate compared to other formats. Finally, the study also provides an KU-60019 cost approach (i.e. Delphi technique) to minimize the bias when determining how to group items into categories. Given these strengths, this study also has limitations. First, it is unknown whether having items with a better difficulty or discrimination level translates into students’ increase in knowledge and application. While these indices should not be the sole measurements used to predict success outside the classroom, they are a starting point. This study suggests that Case-based and dosing items provide our students with greater difficulties. Based on other studies, these Histamine H2 receptor items may be better at assessing and predicting

students’ professional expertise and ranking their performance among their peers. These results are also based on students who may not be representative of other colleges of pharmacy. Nova Southeastern University College of Pharmacy has a very culturally diverse student body consisting of over 240 students per year, with more than 70% of the intake classifying themselves as minorities or from outside of the USA. Therefore, the diversity may explain the unexpected finding that format is more important in determining difficulty than content, indicating that non-native English speakers may struggle more with diverse formats. Lastly, despite having over 500 assessment items, our sample size was small, especially when deconstructed into elements (e.g. format, content). Collaborating with other colleges of pharmacy may assist in obtaining additional items written by other faculty members and answered by other pharmacy students. This will increase the sample size and address the heterogeneity of the data.