Podcast Episode: Passing the NAPLEX the First Time

Welcome to today's episode with our guest Ellie Twedt, a P4 at the University of Iowa College of Pharmacy, where we're diving into a smarter, science-backed way to prepare for the NAPLEX while navigating your APPE rotations. Instead of cramming or waiting until the last minute, we'll explore how to blend real-world learning with proven study techniques from Make It Stick: The Science of Successful Learning. This book highlights three powerful methods for long-term mastery—spaced practice, retrieval practice, and interleaving. We'll focus especially on spaced practice and how it can transform your approach to studying.

Imagine using your RxPrep book not as a giant wall of content, but as a map. As you move through each APPE, you'll connect the rotation experience to the RxPrep chapters that match what you're seeing in the real world. This method turns APPEs into a natural structure for preparing for the NAPLEX, with built-in review and reinforcement along the way. We'll talk about how to link chapters to rotations, create a rotation-based study schedule, and build habits that make your knowledge stick.

If you've ever felt overwhelmed by the sheer volume of material or wondered how to balance NAPLEX prep with the demands of your APPEs, this episode is for you. By the end, you'll have a strategy that transforms studying from a last-minute scramble into a continuous, confident process—one that leverages both your rotations and the science of successful learning.

You can find the free materials she talks about in the interview under "Free General Resources" here:

https://residency.teachable.com/p/extremeloi

Auto Generated Transcript

Hey, welcome to the Pharmacy Residency Podcast. I haven't podcasted in a while, but we've got 500 episodes that you can use as a reference—they're all still out there. We've had a bit of an issue with the NAPLEX, and I think this year presents a real opportunity. This year and next will be, if not the easiest times to get a residency, certainly times with significantly fewer applicants—around 2,000 fewer graduates in each class. One of the best ways to stand out is to show that you're going to pass the NAPLEX, or at least that you're seriously preparing to give it your best shot.

So, I've brought on Ellie Twedt from the University of Iowa. She's a P4 in her second rotation, right? Yep, second rotation. We've asked ourselves: how can we ensure we're putting our best foot forward? We're taking a page out of the book Make It Stick: The Science of Successful Learning. One lesson in there is that spaced practice—essentially, not cramming at the end—is critical. When the NAPLEX rolls around, you don't want to be eight or nine months removed from studying and suddenly find yourself panicking. Unfortunately, that happens often.

We've got some solutions, and Ellie is here to walk us through them. Ellie, tell us a little about yourself—how you got into pharmacy school and Iowa specifically.

Ellie: Yeah, as Tony mentioned, I'm a P4 at the University of Iowa College of Pharmacy. I came to pharmacy through an untraditional path—starting with veterinary medicine. I found I loved both the drug side of things and working with people, so pharmacy felt like the perfect marriage. Being an in-state student, Iowa made sense, and it also gave me the chance to continue my cross country career. It's been a great fit, and I've really enjoyed my time here.

Tony: So you started at Iowa and stayed there. I married into Iowa—that's how I ended up here. Let's shift to talking about NAPLEX pass rates. They've gone down significantly. We're not here to blame anyone, but rather to ask: what can we do about it?

When I was in school, the PharmD was in its first year at Maryland. If I had finished my pre-pharmacy work in two years—some call it "two years of pre-pharmacy"—I could've gone straight into three years of pharmacy school. I did mine in three years. So I would've done three years at the University of Maryland at Baltimore (now University of Maryland, Baltimore). APPEs were only in the final semester: four or five weeks in retail, four to five in hospital, and one elective. That was it. There wasn't much of a gap between finishing classes and taking the NAPLEX.

I graduated in 1996—nearly 30 years ago. It wasn't as easy as choosing between aspirin and Tylenol, but it was simpler. Over the years, complexity has increased—residencies, PGY2s, fellowships, infectious disease, oncology, etc. The exam has grown more challenging. And while you're not allowed to talk about the NAPLEX after taking it, we hear stories: someone gets an all-oncology version, someone else all HIV or cardiology.

Today, students might go 15 to 16 months between finishing didactic work and sitting for the NAPLEX. That's a long gap. You P3s have APPEs that start during your third year, so depending on your schedule, it could be a long stretch between classroom learning and the exam.

Ellie, what's your solution to that gap? And how are you using spaced practice?

Ellie: I just got my enormous RxPrep book—over 1,000 pages. My question was: how can I break this up to make it less overwhelming and use my time wisely? I'm trying to match chapters to my APPEs so I'm walking into each one more prepared.

Tony: And it's even harder now because the questions aren't in the book anymore. That's another $500.

Ellie: Exactly. The content is so big it doesn't fit in one book. So now I read a chapter bit by bit, watch lecture videos for concepts I don't remember, then end with practice questions. That's part of the retrieval practice from Make It Stick.

Tony: Right—trying to recall things helps solidify learning. And it looks great to your preceptor. You make a good first impression if you've reviewed guidelines and identified knowledge gaps beforehand. Instead of asking for help with major gaps two days before the rotation ends, it's better to start strong.

Tell us how you matched chapters to your first APPE and beyond.

Ellie: My first was a community clinical rotation, so I assigned myself chapters on compounding, non-sterile calculations, OTC counseling (allergic rhinitis, tobacco cessation, dietary supplements, etc.). I also drew on my work experience at a compounding pharmacy—placing that content early gave me time for harder chapters later.

Tony: Are you getting into a rhythm now? Some people start with questions first to identify knowledge gaps.

Ellie: I got both the book and online content. I try to read a bit, then watch videos if I get stuck, and then do test questions to reinforce the concepts.

Tony: That makes sense. You're combining spaced and retrieval practice. Also, your preceptors don't have a packet of your history—they only know you're supposed to be prepared. Showing initiative and acknowledging gaps helps them help you.

Now, you're in your academic block, which gives you more time. What chapters did you assign yourself?

Ellie: I'm using this time to cover foundational science—lab values, drug references, etc.—that will set me up for acute care and ambulatory care later. I'm also catching up on any chapters I didn't get to.

Tony: Great. What's your next APPE?

Ellie: I'm heading to Amber Pharmacy in Omaha—a specialty rotation focused on hepatitis C, oncology, MS, and Crohn's. I assigned myself chapters on liver disease, transplant, cystic fibrosis, and sickle cell.

Tony: Oncology is always a beast. Just know your limits—don't try to impress a BCOP with guesses. It's better to say what you do and don't know. Next rotation?

Ellie: Acute care at Gundersen Lutheran in La Crosse, Wisconsin. I focused on more acute chapters—things I haven't covered yet but need to know.

Tony: Makes sense. Did your preceptors give you guidance on which chapters to prioritize?

Ellie: Yes, and I tried to be strategic—less time in heavier blocks, more content when I have flexibility.

Tony: Next?

Ellie: Infectious disease in Iowa City. I already did the ID elective, so I'm reviewing those chapters again, plus HIV and drug allergy.

Tony: HIV can get really deep. Are you planning to take a practice NAPLEX?

Ellie: Possibly. It might help assess whether I'm on track.

Tony: Agreed. Okay, what's next?

Ellie: Ambulatory care in Sioux City at a family medicine clinic—focusing on chronic disease and neurology. Also spacing out some community chapters.

Tony: You'll probably be doing MTMs. Those can be a grind.

Ellie: Yeah, calling patients who don't want to be called... fun times.

Tony: After that?

Ellie: An elective pharmacy rotation at One Arrow Rx in West Des Moines—they serve Metacap facilities and offer clinical services. I put more community topics there to balance the load.

Tony: Final rotation?

Ellie: My hospital rotation at Mary Greeley in Ames.

Tony: So you'll finish with inpatient. That's great. You mentioned challenges—what were the biggest ones in making your schedule?

Ellie: First, assigning chapters to my most specific rotations helped narrow things down. Then I realized RxPrep lists estimated study times for each chapter, which I hadn't considered. I'd go back and balance chapter hours more evenly across blocks if I had to revise.

Tony: You're being hard on yourself. Just having this mapped out is a huge win. Final thoughts?

Ellie: Nope, I think we covered everything. Thanks for having me.

Tony: Thanks for being on the Pharmacy Residency Podcast!