Yukinori Nagakura

Attendance format may be associated with the learning-support effects of preparatory courses for the National Examination for Pharmacists (NEP). This retrospective observational study examined associations of self-selected attendance format with course-period learning gain and subsequent NEP performance in a four-month HyFlex course for sixth-year pharmacy students. Students received the same course content and examinations and were classified into face-to-face (F2F), live online (LO), or mixed (MIX) attendance groups. Course-period learning gain was defined as the difference in examination score percentage between the post-course and pre-course examinations. The F2F group showed greater learning gain than the LO and MIX groups. Although the NEP pass rate was higher in the F2F group, the difference among groups did not reach statistical significance in the primary analysis (p = 0.086). Similar findings were observed in a sensitivity analysis. In conclusion, F2F attendance was associated with greater course-period learning gain than LO or MIX attendance. However, this advantage was not clearly reflected in NEP outcomes, indicating that course-period learning gain alone may not fully explain final examination performance and continued post-course support may be needed. Because the attendance format was self-selected, these findings should not be interpreted as evidence of a causal effect.

INTRODUCTION: In Japanese pharmacy education, success on the National Pharmacist Examination is a key objective. This study evaluated learning gain across face-to-face, mixed-attendance, and live online participation patterns in a four-month HyFlex National Pharmacist Examination preparation course under controlled conditions. METHODS: Sixth-year pharmacy students at Musashino University, Tokyo, Japan, participated in a four-month HyFlex course and chose their attendance mode for each session. Students with ≥90% attendance who completed the pre- and post-course examinations were classified as face-to-face (≥75% in-person attendance), live online (≥75% online attendance), or mixed-attendance (<75% in either modality). Learning gain was defined as the post-course examination correct-answer rate (%) minus the pre-course examination correct-answer rate (%). RESULTS: The overall cohort (n = 208) showed a learning gain of 16.9 ± 0.5%. Learning gain was 20.2 ± 1.2% in the face-to-face group (n = 23), 16.4 ± 0.8% in the mixed-attendance group (n = 41), and 16.5 ± 0.6% in the live online group (n = 144). Learning gain tended to be higher in the face-to-face group than in the mixed-attendance group (p = 0.061; d = 0.736) and was higher than in the live online group (p = 0.028; d = 0.546), whereas the mixed-attendance and live online groups showed nearly identical learning gain (p = 0.998; d = 0.010). CONCLUSIONS: These findings support the educational value of HyFlex as a flexible learning environment. Face-to-face participation was associated with greater learning gain than live online participation, whereas mixed-attendance and live online participation showed similar learning gain.