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E-cigarette licensure laws (ELLs) require retailers to obtain a state license to sell e-cigarettes over the counter. This study is the first to comprehensively explore the effect of ELL adoption on youth tobacco product use. Using data from the State Youth Risk Behavior Survey (YRBS) and a difference-in-differences approach, we find no evidence that ELL adoption reduces youth ENDS use. The precision of our estimates allows us to rule out, with 95 % confidence, ELL-induced declines in prior-month, frequent, and everyday youth ENDS use of more than 0.7, 0.3, and 0.4 percentage points, respectively. The pattern of null findings persists when we examine ELLs that impose higher penalties for retailer non-compliance, higher renewable licensure fees, and criminal in addition to civil penalties. We conclude that ELLs have only limited success in curbing access to ENDS among youths.

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BACKGROUND: In the age of automation and technology, incorporating empathy in pre-licensure healthcare education is essential in providing empathic care to patients and co-workers. This can be achieved through interprofessional education (IPE). OBJECTIVE: To consolidate evidence to evaluate interprofessional education's impact on pre-licensure healthcare students' empathy levels. DESIGN: A mixed-studies systematic review following a convergent segregated approach. METHODS: Ten electronic databases were searched from their inception until 30 November 2023. Quantitative, qualitative, and mixed-method studies that explored the impact of IPE on the change in empathy level in pre-licensure healthcare students were reviewed. The methodological quality of the included studies was assessed using the Mixed-Method Appraisal Tool. Findings from the qualitative and quantitative aspects were analysed and synthesized separately using thematic and narrative synthesis. The findings were integrated by convergent synthesis. RESULTS: A total of 36 studies involving 3887 participants were included in this review, consisting of five quantitative, 14 qualitative and 17 mixed-methods studies. This review found that IPE enhanced the empathy level of students by improving their understanding of empathy and various empathic responses. Through IPE activities, students demonstrated empathy towards both patients and interprofessional peers. Three themes were generated through the synthesis of qualitative and quantitative results: (1) Empathy Awareness, (2) Internal Empathic Processes, and (3) Intentional Actions. The results showed that healthcare students exhibited empathic care behaviours towards patients and their interprofessional peers. CONCLUSION: The findings of this review suggested that IPE was effective in improving awareness and knowledge of empathy and in providing empathy care to patients and interprofessional peers. This review encourages educators to implement IPE to pre-licensure healthcare students to increase their knowledge of the importance of providing empathic patient care and interprofessional empathy. Future research could explore more on the processes of interprofessional empathy in students.

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OBJECTIVE: To identify if there is a relationship between the placement of standalone pharmacy law courses within the PharmD curriculum and Multistate Pharmacy Jurisprudence Examination (MPJE) first-time pass rates. METHODS: Colleges of pharmacy were identified using the MPJE Passing Rates for 2019-2022 Graduates found on the National Association of Boards of Pharmacy (NABP) website. Characteristics of the pharmacy law content delivery within the curriculum were extracted from the program, Pharmacy College Application Service, American Association of Colleges of Pharmacy (AACP), and NABP websites. Pharmacy programs with standalone law courses, MPJE pass rates reported by NABP, and data that could be obtained via publicly available sources were included. To standardize between three year and four-year programs, law course delivery within the curriculum was measured as number of semesters (fall, spring, or summer) before graduation. RESULTS: One hundred nine schools met the inclusion criteria. Linear path analysis revealed no relationship between the number of semesters a law course was scheduled before graduation and 4-year average first-time MPJE pass rates and 4-year average all-time MPJE pass rates. CONCLUSION: The findings did not show that earlier placement of pharmacy law courses predicted MPJE first-time pass rates. However, a strong correlation existed between NAPLEX and MPJE pass rates, suggesting NAPLEX performance may indicate overall licensure exam preparedness. Notable differences in pass rates were observed between public and private pharmacy programs, highlighting the need to investigate program characteristics impacting exam success. Further research is warranted to identify predictive factors for MPJE outcomes.

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BACKGROUND: The ability of an expert's item difficulty ratings to predict test-taker actual performance is an important aspect of licensure examinations. Expert judgment is used as a primary source of information for users to make prior decisions to determine the pass rate of test takers. The nature of raters involved in predicting item difficulty is central to set credible standards. Therefore, this study aimed to assess and compare raters' prediction and actual Multiple-Choice Questions' difficulty of the undergraduate medicine licensure examination (UGMLE) in Ethiopia. METHOD: 815 examinees' responses to 200 Multiple-Choice Questions (MCQs) were used in this study. The study also included experts' item difficulty ratings of seven physicians who participated in the standard settings of UGMLE. Then, analysis was conducted to understand experts' rating variation in predicting the actual difficulty levels of examinees. Descriptive statistics was used to profile the mean rater's and actual difficulty value for MCQs, and ANOVA was used to compare the mean differences between raters' prediction of item difficulty. Additionally, regression analysis was used to understand the interrater variations in item difficulty predictions compared to the actual difficulty. The proportion of variance of actual difficulty explained from rater prediction was computed using regression analysis. RESULTS: In this study, the mean difference between raters' prediction and examinees' actual performance was inconsistent across the exam domains. The study revealed a statistically significant strong positive correlation between the actual and predicted item difficulty in exam domains eight and eleven. However, a non-statistically significant very weak positive correlation was reported in exam domains seven and twelve. The multiple comparison analysis showed significant differences in mean item difficulty ratings between raters. In the regression analysis, experts' item difficulty ratings of the UGMLE had 33% power in predicting the actual difficulty level. The regression model also showed a moderate positive correlation (R = 0.57) that was statistically significant at F (6, 193) = 15.58, P = 0.001. CONCLUSION: This study demonstrated the complex process for assessing the difficulty level of MCQs in the UGMLE and emphasized the benefits of using experts' ratings in advance. To ensure the exams maintain the necessary reliable and valid scores, raters' accuracy on the UGMLE must be improved. To achieve this, techniques that align with the evolving assessment methodologies must be developed.

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Policy Points The reinstitution of pre-COVID-19 pandemic licensure regulations has impeded interstate telehealth. This has disproportionately impacted patients who live near a state border; geographically mobile patients, such as college students; and patients with rare diseases who may need care from a specialist outside their state. Several promising and feasible reforms are available, at both state and federal levels, to facilitate interstate telehealth. For example, states can offer exemptions to licensure requirements for certain types of telehealth such as follow-up care or create licensure registries that impose little reduced paperwork and fees on physicians. On the federal level, congressional interventions that mimic the Department of Veterans Affairs Maintaining Internal Systems and Strengthening Integrated Outside Networks (VA MISSION) Act of 2018 can waive provider licensing and geographic restrictions to telehealth within certain federal programs such as Medicare. Any discussion of medical licensure reform, however, must also consider the current political climate, one in which states are taking divergent stances on sensitive topics such as reproductive care, gender-affirming care, and substance use treatments.

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Two states-Connecticut and New Hampshire-have created or attempted to create advanced pharmacy technician (APhT) licenses. Both licenses, proposed and actual, have high barriers to entry, such as requiring 1 to 3 years of prior technician experience and passage of various assessments or trainings, such as a state-specific jurisprudence exam. Those obtaining APhT licensure are granted additional authority, such as performing final product verification (e.g., tech-check-tech) and vaccine administration. Compared with practices in other states, the APhT role in CT and NH provides minimal scope gains relative to the requirements imposed; as a result, there has been limited uptake (<1%) among current technicians. As such, it appears unlikely that tiered licensure for technicians will be the preferred mechanism for states to expand the role of pharmacy technicians in the future.

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CONTEXT: Failure of students to pass the National Medical Licensure Examination (NMLE) is a major problem for universities and the health system in Japan. To assist students at risk for NMLE failure as early as possible after admission, this study investigated the time points (from the time of admission to graduation) at which predictive pass rate (PPR) can be used to identify students at risk of failing the NMLE. METHODS: Seven consecutive cohorts of medical students between 2012 and 2018 (n = 637) at the Gifu University Graduate School of Medicine were investigated. Using 7 variables before admission to medical school and 10 variables after admission, a prediction model to obtain the PPR for the NMLE was developed using logistic regression analysis at five time points, i.e., at admission and the end of the 1st, 2nd, 4th, and 6th grades. All students were divided into high (PPR < 95%) and low (PPR ≥ 95%) risk groups for failing the NMLE at the five time points, respectively, and the movement between the groups during 6 years in school was simulated. RESULTS: Medical students who passed the NMLE had statistically significant factors at each of the 5 time points, and the number of significant variables increased as their grade in school advanced. In addition, two factors extracted at admission were also selected as significant variables at all other time points. Especially, age at entry had a consistent and significant effect during medical school. CONCLUSIONS: Risk analysis based on multiple variables, such as PPR, can inform more effective intervention compared to a single variable, such as performance in the mock exam. A longer prospective study is required to confirm the validity of PPR.

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Purpose Concerns regarding the ethical justification for the use of single-encounter, procedure-based examinations on live patients for the licensure of dental hygienists and dentists in the United States persists despite decades of debate and publication on the subject. The purpose of this literature review was to summarize the specific ethical concerns and quantify recommendations in favor or against this examination methodology.Methods A population, intervention, control or comparison, outcome (PICO) question was developed to review the topic as follows: "For individuals receiving dental care as part of determination of candidates for competency and readiness for licensure, do patient-based licensure examinations, as compared to other assessment methods, violate or infringe upon ethical principles or ethical standards for health care or society?" An electronic search was performed in three databases: PubMed/Medline, Scopus, and Embase. Key search terms and Medical Subject Headings (MeSH) included the following: ethics, clinical, competence, dental, dental hygiene, dentistry, education, licensure, live patient, and practice.Results Ethical concerns about the use of patient examinations have been published in the professional literature for over 35 years. Of the 29 selected or endpoint articles identified, 27 articles cited one or more ethical concerns relating to single-encounter patient-based examinations while 20 articles recommended the elimination of this type of examination with an additional 6 articles citing elimination as an option in resolving the ethical issues regarding this type of licensure examination.Conclusion The literature holds a predominant, prevailing professional opinion that single-encounter, procedure-based examinations on live patients presents significant ethical concerns and should be eliminated as a method in initial dental hygiene and dental licensure. The literature also suggests that state dental boards should initiate corrective regulatory or legislative actions to expeditiously end recognition of live patient examinations in their licensure processes.

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The establishment of the National Practitioner Data Bank (NPDB) was authorized in the Health Care Quality Improvement Act of 1986, and it mandated a federal database to collect information related to adverse actions initially against just physicians and dentists throughout the United States, including payments from malpractice lawsuits, restrictions on clinical privileges by hospitals, and medical licensure limitations and revocations by state licensing boards. The aggregate data reports made by this federal data bank began in 1991. The reporting level for the first ten years remained relatively stable in the nationwide range of 16,000 to 18,000 reports per year, but then a steady decline occurred over the second and third decades to under 8,000 reports per year by the year 2021. The researchers in this study explored a theory that might explain at least part of the drop in the states' reporting levels. That is, states that could be called "Plaintiff-Favorable" (Arizona, Kentucky, New York, Pennsylvania, and Washington) would demonstrate a lesser rate of decline or even an increase in the reporting levels, and states that could be characterized as "Defendant-Favorable" (California, Michigan, Nevada, North Carolina, and Texas) would demonstrate a comparatively greater rate of decline in the reporting levels. The decline in reporting to the NPDB proved fairly consistent for both Plaintiff-Favorable and Defendant-Favorable states. The larger question as to why there occurred an overall negative trend in reporting to the NPDB across the United States during the second and third decades remains an intriguing area for future exploration.

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OBJECTIVE: Pharmacist licensure exam first-time pass rates have declined for several years. Predictors of licensure exam performance, including the Pharmacy College Admission Test, are no longer required, necessitating alternative strategies. Our aim is to assess the relationship between numerical scores on advanced pharmacy practice experience (APPE) exams and pharmacist licensure exams first-time pass rates. METHODS: We conducted a single-center, retrospective, observational analysis. APPE examination results between May 2020 and November 2023 were analyzed for association with licensure information from the Texas State Board of Pharmacy. Exam scores were collected for student cohorts graduating from 2021 to 2022 as study cohort data. Correlation between exam scores and probability of successful licensure was assessed using logistic regression. A classification and regression tree analysis identified the most significant threshold. Predictive ability of the best-fit model was prospectively validated using the 2023 graduate cohort. RESULTS: The overall licensure success rate was 80.6% for the study cohort (2021-2022, n = 206). Exam scores were well correlated to the likelihood of licensing success. The most significant threshold was 77.8%. The success rate was 82.5% vs 16.7% for those scoring above and below the threshold, respectively. The observed and predicted licensure success rates were 91.0% and 88.8%, respectively, in the validation cohort (2023, n = 89). The positive and negative prediction values were 94.9% and 40.0%, respectively. CONCLUSION: The performances on APPE exams were reasonable in predicting the first-time licensure success rate for a graduating class. Our assessment appears promising as a risk-stratification tool for students in gaining successful pharmacist licensure.

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BACKGROUND: Significant reforms are occurring in health practitioner regulation across Canada. Within the nursing profession, growing workforce challenges and health system demands have accelerated the pace of changes to nursing regulation policies and practices. There is significant political investment to modernize and harmonize nursing regulation across Canada, and evidence is needed to guide regulatory decision-making. To better understand the current state of scholarship and the gaps that exist, a comprehensive understanding of the available literature informing nursing regulation in Canada is first warranted. OBJECTIVE: The objective of this scoping review is to examine the nature, extent, and range of literature focused on nursing regulation in Canada. METHODS: The review will be conducted in accordance with the Joanna Briggs Institute guidelines for scoping reviews. We will search electronic databases, including Ovid MEDLINE, Ovid EMBASE, CINAHL, Scopus, and Web of Science Core Collection. We will also search for grey literature using the websites of Canadian nursing regulatory bodies, nursing organizations, and other leading Canadian regulatory organizations. No limitations will be placed on the year of publication. The review will include papers that explore nursing regulation in Canada, including topics such as education program accreditation or approval, licensure, standards of practice and code of conduct/ethics development and enforcement, continuing competence, discipline and conduct, regulatory models, governance, and reform. We will extract data using a predeveloped tool. Data will be analyzed using descriptive statistics and conventional content analysis. RESULTS: A preliminary search in Ovid MEDLINE was undertaken on December 7, 2023, and a full search was conducted in 5 academic databases on March 15, 2024. Findings will be presented using evidence tables and a narrative summary. Reporting will follow the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) guidelines. This scoping review is expected to be completed in early 2025. CONCLUSIONS: The results will be disseminated through conference presentations and a publication in a peer-reviewed journal. The findings will provide a comprehensive overview of the state of nursing regulation literature across Canada and inform the development of a focused research agenda. TRIAL REGISTRATION: Open Science Framework osf.io/3qk8t; https://osf.io/bm7jv. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/56163.

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OBJECTIVE: To investigate interview and match outcomes of medical students who received pass/fail USMLE reporting vs medical students with numeric scoring during the same period. DESIGN: Retrospective analysis of a cross-sectional survey-based study. SETTING: United States 2023 residency match. PARTICIPANTS: Medical student applicants in the 2023 residency match cycle who responded to the Texas Seeking Transparency in Application to Residency (STAR) survey. RESULTS: Among 6756 applicants for the 2023 match, 496 (7.3%) took USMLE Step 1 with pass/fail reporting. Pass/fail reporting was associated with lower USMLE Step 2-CK scores (245.9 vs 250.7), fewer honored clerkships (2.4 vs 3.1), and lower Alpha Omega Alpha membership (12.5% vs 25.2%) (all p < 0.001). Applicants with numeric USMLE Step 1 scores received more interview offers after adjusting for academic performance (beta coefficient 1.04 (95% CI 0.28-1.79); p = 0.007). Numeric USMLE Step 1 scoring was associated with more interview offers in nonsurgical specialties (beta coefficient 1.64 [95% CI 0.74-2.53]; p < 0.001), but not in general surgery (beta coefficient 3.01 [95% CI -0.82 to 6.84]; p = 0.123) or surgical subspecialties (beta coefficient 1.92 [95% CI -0.78 to 4.62]; p = 0.163). Numeric USMLE Step 1 scoring was not associated with match outcome. CONCLUSIONS: Applicants with numeric USMLE Step 1 scoring had stronger academic profiles than those with pass/fail scoring; however, adjusted analyses found only weak associations with interview or match outcomes. Further research is warranted to assess longitudinal outcomes.

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Interprofessional collaboration (IPC) in stroke care is accepted as best practice and necessary given the multi-system challenges and array of professionals involved. Our two-part stroke team simulations offer an intentional interprofessional educational experience (IPE) embedded in pre-licensure occupational therapy, physical therapy, pharmacy, medicine, nursing and speech-language pathology curricula. This six-year mixed method program evaluation aimed to determine if simulation delivery differences necessitated by COVID-19 impacted students' IPC perception, ratings, and reported learning. Following both simulations, the Interprofessional Collaborative Competency Assessment Scale (ICCAS) and free-text self-reported learning was voluntarily and anonymously collected. A factorial ANOVA using the ICCAS interprofessional competency factors compared scores across delivery methods. Content and category analysis was done for free-text responses. Overall, delivery formats did not affect positive changes in pre-post ICCAS scores. However, pre and post ICCAS scores were significantly different for interprofessional competencies of roles/responsibilities and collaborative patient/family centered approach. Analysis of over 10,000 written response to four open-ended questions revealed the simulation designs evoked better understanding of others' and own scope of practice, how roles and shared leadership change based on context and client need, and the value of each team member's expertise. Virtual-experience-only students noted preference for an in-person stroke clinic simulation opportunity.

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This article discusses four questions. First, what is the operational framework of the Association of Social Work Boards (ASWB)? Second, how congruent is the ASWB's operational framework with social work values and ethics? Third, why do ASWB exam candidates from disadvantaged backgrounds-those who identify as African American, who are older, and who do not speak English as a first language-register comparatively lower pass rates in the clinical licensure examination? Fourth, what are ethically sound novel strategies for improving the ASWB exam? This article argues that (1) ASWB, in its present state, operates under a business model philosophy, which is incongruent with the social work value of integrity, and (2) the disparities in pass rates in the ASWB exam may reflect its lack of validity. This article also presents three relatively innovative strategies for restoring confidence and increasing success in the ASWB social work licensing exam and two contingent solutions to the problem of exam pass rate disparities based on race, age, and primary language. The implications of this study for social work stakeholders are also discussed.

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In 2021, there were 11.7 million licensed young drivers in the U.S. This is 1.5 million fewer young drivers compared to 2007. The phenomenon of delay in driving licensure among teens has notable implications for opportunities positioning them for life success when transitioning into emerging adulthood and in later life.

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CONTEXT: Osteopathic (Doctor of Osteopathic Medicine [DO]) medical students account for more than 25 % of all medical students in the United States. OBJECTIVES: This study examined the predictive validity of Medical College Admission Test (MCAT) total scores and cumulative undergraduate grade point averages (UGPAs) for performance on the Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX-USA) Level 1 and Level 2-CE (Cognitive Evaluation) licensure examinations administered by the National Board of Osteopathic Medical Examiners (NBOME). Additionally, the study examined the degree to which MCAT total scores and UGPAs provide comparable prediction of student performance by key sociodemographic variables. METHODS: This study involved a collaborative effort between the Association of American Medical Colleges (AAMC), the American Association of Colleges of Osteopathic Medicine (AACOM) and the NBOME. Data were examined for 39 accredited DO-granting medical schools in the United States during the 2017 application cycle. Researchers utilized three regression models that included MCAT total scores, cumulative UGPA, and combined MCAT total scores and cumulative UGPA to determine predictive validity. Researchers also examined the comparability of prediction for sociodemographic variables by examining the differences between observed and predicted error for both scores and pass/fail success rates. RESULTS: Medium to large correlations were discernible between MCAT total scores, UGPA, and COMLEX-USA examination outcomes. For both COMLEX-USA Level 1 and Level 2-CE scores and pass/fail outcomes, MCAT scores alone provided superior predictive value to UGPA alone. However, MCAT scores and UGPA utilized in conjunction provided the best predictive value. When predicting both licensure examination scores and pass/fail outcomes by sociodemographic variables, all three models provided comparable predictive accuracy. CONCLUSIONS: Findings from this comprehensive study of DO-granting medical schools provide evidence for the value-added benefit of taking MCAT scores and UGPA into consideration, particularly when these measures are utilized in conjunction. Further, findings provide evidence indicating that individuals from different sociodemographic backgrounds who enter medical school with similar MCAT scores and UGPA perform similarly on licensure examination outcome measures.

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OBJECTIVE: Since 1963 the Canadian Chiropractic Examining Board has conducted competency examinations for individuals seeking licensure to practice chiropractic in Canada. To maintain currency with changes in practice, examination content and methodology have been regularly updated since that time. This paper describes the process used by the Canadian Chiropractic Examining Board to restructure the examination to ensure it was current and to align it with the 2018 Federation of Canadian Chiropractic's Canadian Chiropractic Entry-to-Practice Competency Profile. METHODS: A subject-matter-expert committee developed proposed candidate outcomes (indicators) for a new examination, derived from the competency profile. A national survey of practice was undertaken to determine the importance and frequency-of-use of the profile's enabling competencies. Survey results, together with other practice-based data and further subject-matter-expert input, were used to validate indicators and to create a new structure for the examination. RESULTS: The new examination is a combination of single-focus and case-based multiple-choice questions, and OSCE (objective, structured, clinical examination) methodology. Content mapping and item weighting were determined by a blueprinting committee and are provided. CONCLUSION: Administration of the new examination commenced in early 2024.

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Background: In Canada, internationally educated physiotherapists (IEPTs) and occupational therapists (IEOTs) may work as occupational/physical therapy assistants (OTAs/PTAs) while pursuing Canadian licensure. This experience presents personal and professional opportunities and challenges. Purpose: We explored a) the barriers and facilitators experienced by IEPTs and IEOTs working as OTAs/PTAs while pursuing licensure in Canada and b) how might their professional identity changes during this period. Methods: In this cross-sectional qualitative study, we sampled IEPTs and IEOTs working as assistants using online focus groups. Reflexive thematic analysis of data was used to generate themes. Findings: Fourteen IEPTs or IEOTs participated reporting barriers including financial impacts while working as an OTA/PTA, discrimination, and challenges completing licensing exams. Facilitators while working as OTA/PTAs included social support, acculturation with Canadian systems, and career opportunities. Changes to professional identity encompassed accepting a new identity, reclaiming their old identity, or having a strong sense of identity within a healthcare profession. Participants advocated for bridging programs and modifications for examination processes for IEPTs and IEOTs to improve their experiences while pursuing licensure in Canada. Conclusion: Increased advocacy is needed to address the current experiences of IEPTs and IEOTs working as OTA/PTAs after migration.

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This article delves into the role of ChatGPT within the rapidly evolving field of artificial intelligence, especially highlighting its significant potential in nursing education. Initially, the paper presents the notable advancements ChatGPT has achieved in facilitating interactive learning and providing real-time feedback, along with the academic community's growing interest in this technology. Subsequently, summarizing the research outcomes of ChatGPT's applications in nursing education, including various clinical disciplines and scenarios, showcases the enormous potential for multidisciplinary education and addressing clinical issues. Comparing the performance of several Large Language Models (LLMs) on China's National Nursing Licensure Examination, we observed that ChatGPT demonstrated a higher accuracy rate than its counterparts, providing a solid theoretical foundation for its application in Chinese nursing education and clinical settings. Educational institutions should establish a targeted and effective regulatory framework to leverage ChatGPT in localized nursing education while assuming corresponding responsibilities. Through standardized training for users and adjustments to existing educational assessment methods aimed at preventing potential misuse and abuse, the full potential of ChatGPT as an innovative auxiliary tool in China's nursing education system can be realized, aligning with the developmental needs of modern teaching methodologies.