To examine whether students’ scores on pharmacy practice didactic examinations and skills-based, performance-oriented assessments are associated with their outcomes during advanced pharmacy practice experiences (APPEs).A retrospective study was conducted using records from graduates between 2018 and 2020. Students were classified as poor APPE performers (final APPE grade <83 percent) or acceptable performers. Examination results and performance-based assessment scores from pharmacy practice didactic and skills-focused courses completed in the second and third professional years were analyzed, applying predefined grade thresholds aligned with course cutoffs. Associations between low mean examination scores, performance-based assessments, and APPE performance were evaluated.Among 403 graduates, analyzable sample sizes varied from 254 to 403. Forty-nine students (12%) were identified as poor performers during the APPE year. In comparisons of didactic course outcomes with APPE performance, mean examination scores below 83% in six of seven pharmacy practice didactic courses were significantly associated with poor APPE performance, while five of seven courses showed significant associations at the <78 percent threshold. Several performance-based assessments demonstrating significant associations with APPE underperformance emphasized higher-order cognitive and critical thinking skills.The findings reveal a gap in early detection of students who ultimately perform poorly during APPEs despite passing didactic coursework. Emphasizing assessments that require critical thinking within the pre-APPE curriculum may improve early identification of at-risk students. Such approaches may be transferable to other pharmacy programs seeking curricular indicators to guide targeted academic support before the APPE year.
