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Assessment of English language performance scores and academic

performance in an English-based curriculum for pharmacy students with
English as a second language

Article  in  Currents in Pharmacy Teaching and Learning · December 2019

DOI: 10.1016/j.cptl.2019.12.029

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Currents in Pharmacy Teaching and Learning

journal homepage: www.elsevier.com/locate/cptl

Research Note

Assessment of English language performance scores and academic

performance in an English-based curriculum for pharmacy students
with English as a second language
⁎
Justin W. Tenneya, , Maria Paivab, Qianwen Wangc
a
School of Pharmacy, West Coast University, 590 North Vermont Ave, Los Angeles, CA 90004, United States
b
Sidra Medicine, Doha, Qatar
c
School of Pharmacy, Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, 1700 4th Street, Bioengineering
and Therapeutic Sciences, 5/F, San Francisco, CA 94158, United States

A R T IC LE I N F O ABS TRA CT

Keywords: Background: The primary objective was to determine if there is a relationship between English
Pharmacy language performance and graduating grade point average (GPA) in pharmacy students with
Pharmacy student English as a second language (ESL).
Education Methods: Students graduating from a four-year pharmacy program in 2016–2018 were invited to
English as a second language
participate in the study. We compared pharmacy students' pre-admission ESL scores to their
Admissions
cumulative GPA at graduation in each of the three graduating cohorts and also determined if
these results held true for both genders. Correlation of GPA to individual mathematics, chemistry,
and Chinese language scores were used as points of reference to compare the degree of corre-
lation.
Results: There were 148 students screened for the study with 31 students not meeting the in-
clusion criteria and four students declining to participate. Statistical analyses show an overall
weak correlation. There was a statistically significant stronger correlation between pre-admission
ESL scores and cumulative graduating GPA (r = 0.273) as compared to the correlation of GPA
with mathematics (r = 0.187), chemistry (r = 0.181), or Chinese language scores (r = 0.059).
The results did not change when the study population was separated by gender as English score
still had the strongest correlation as compared to the other subjects.
Conclusion: This study provides evidence that English language scores correlate more strongly
with academic performance than mathematics, chemistry, or Chinese language scores in ESL
pharmacy students. Also, this English language correlation is stronger for females than males.

Introduction

The diversity of students admitted into healthcare education programs and the international adoption of curriculums delivered
predominantly in English are likely increasing alongside globalization.1 English language skills difficulty has been identified as a
main concern for English as a second language (ESL) students in a healthcare program.2 Academic success is considered a strong
indicator of postgraduate achievement.3
It is important to identify what attributes are predictors of student success when designing admission criteria for a program to

⁎
Corresponding author.
E-mail addresses: jtenney@westcoastuniversity.edu (J.W. Tenney), mpaiva@sidra.org (M. Paiva), qianwen.wang@ucsf.edu (Q. Wang).

https://doi.org/10.1016/j.cptl.2019.12.029

1877-1297/ © 2019 Elsevier Inc. All rights reserved.

Please cite this article as: Justin W. Tenney, Maria Paiva and Qianwen Wang, Currents in Pharmacy Teaching and Learning,
https://doi.org/10.1016/j.cptl.2019.12.029
J.W. Tenney, et al. Currents in Pharmacy Teaching and Learning xxx (xxxx) xxx–xxx

offer students the best chance to succeed. Higher preadmission chemistry scores were believed to be the best test score to predict
academic success in pharmacy school despite mixed literature on the relationship between preadmission chemistry courses or scores
and academic success in pharmacy school.4,5 However, as pharmacy school curriculums adapt to incorporate more clinical com-
ponents, this belief has faded and now other applicant assessments may be potentially more accurate.
English language performance tests are often a component of admission criteria in most pharmacy schools for ESL students, which
is the current practice for Hong Kong pharmacy schools.6 Current literature assessing English language performance's effect on
success of healthcare students is limited to nursing and medical students.7–12 Literature is also limited to just one to two years of the
healthcare academic program.7–12 The majority of the articles show that English language performance is significantly related to
academic success in the first and second years of the program in nursing and medical students.7–12 Only one study by Zheng et al.12
has shown that English language ability does not correlate to academic success in a healthcare program. This lone study evaluated
one-year drop-out rate in nursing students as the surrogate marker rather than GPA.12
This study aims to add three new components to the current limited literature. Firstly, this study evaluates those with Cantonese
(Chinese) as a first language. Secondly, this study evaluates ESL pharmacy students. Lastly, this study compares preadmission scores
to graduating cumulative four-year grade point average (GPA). The primary outcome is to assess for a relationship between pre-
admission English exam scores and cumulative graduating GPA. Secondary outcomes include comparing other preadmission scores,
including mathematics, chemistry, and Chinese language scores, to determine if there is a correlation with GPA at the end of every
year throughout the four-year curriculum and cumulative GPA upon graduation. We also separated students into male or female
categories to identify if the findings hold true for both genders.

Methods

This study was conducted at a public university in Hong Kong where the majority of students do not claim English as a first
language and English is the primary language of instruction. Pharmacy students graduating from the four-year program in 2016
through 2018 were invited to participate in the current study. Students enrolled in this pharmacy program are generally admitted
directly from secondary school. Students were excluded from the study if they meet any one of four following criteria: (1) did not
complete the local tertiary education university preadmission exam (Hong Kong Diploma of Secondary Education Examination:
HKDSE); (2) English as a first language; (3) declined to participate in the study; (4) not admitted directly from secondary school. The
HKDSE exam is a validated assessment that contains six subjects including mathematics, Chinese language, English, and liberal
studies as mandatory subjects.13 The HKDSE is taken at the end of senior secondary education (i.e. year 12). The scores from the
HKDSE in all subjects are categorical and range from 1 to 7 with 7 being the best possible score. Both Chinese language and English
language components of the HKDSE include speaking, listening, reading, and writing components.
Background demographic information was collected including gender, ethnicity, and year of graduation information in addition
to preadmission test scores and GPA at the end of academic school year. Appendix 1 shows the curriculum of the Bachelor of
Pharmacy program. We chose these three graduating cohorts because there were dramatic changes in the curriculum prior to these
classes, with minimal changes to the curriculum between these three classes. The overall structure of the pre-admission exam was the
same throughout all three cohorts, however level of difficulty may vary somewhat from year to year.
All students were asked to provide informed consent prior to enrolment. We obtained approval from the university survey and
behavioural ethics board prior to conducting this study. The dataset was analysed using Rstudio version 1.2.1335 (Rstudio,Inc.,
Boston, MA, USA).14 Two independent variables were used in our study: (1) pre-admission results including English, mathematics,
chemistry, and native language (Chinese) scores; (2) academic performance in pharmacy program including the GPA of each aca-
demic years and cumulative GPA at graduation. Pre-evaluation and visualization of the dataset was conducted. The distribution of all
mentioned variables was evaluated since the types of data include dichotomous data and categorical data. Moreover, the effect of
gender, ethnicity, and year of graduation were tested in both pre-admission ESL results and GPA using one-way ANOVA. Then the
relationship between the students' pre-administration ESL results and their academic performance in the pharmacy program after
admission was analysed using Spearman correlation. The comparisons are independent of each other, based on the assumptions of
Spearman's test. In addition, multiple correction approaches including Bonferroni correction, Holm correction and ANOVA with
Tukey's approach were applied to evaluate the influence on multiple comparisons. A p value of < 0.05 was considered statistically
significant.

Results

There were 148 students screened for enrolment in the study with 35 being excluded. All students enrolled are of Han Chinese
ethnicity with a gender distribution of 49% female and 51% male. The exact ages of the participants are unknown other than all
students enrolled were aged between 17 and 26 years of age. Screening and enrolment of study participants are shown in Fig. 1. The
average graduating GPA of students was 3.3 on a scale of 0 to 4.0. This did not vary significantly from year to year throughout the
curriculum.
Effects of gender and graduation year were evaluated on both pre-admission scores and GPA. Pre-admission scores and GPAs did
not vary between genders. However, a difference was seen from math pre-admission exam scores from year to year (p < .01).
Students were further divided into three different cohorts based on their graduation year before conducting correlation analyses,
which are shown in Table 1. Pre-admission English language exam scores of the three cohorts (students graduating in 2016, 2017,
2018, respectively) were all correlated with their first year GPA (r = 0.321, p = .022; r = 0.473, p = .008; r = 0.387, p = .029).

2
J.W. Tenney, et al. Currents in Pharmacy Teaching and Learning xxx (xxxx) xxx–xxx

Fig. 1. Number students screened and enrolled in the study.

Table 1
Correlation of preadmission exam scores with grade point average.
Year of graduation Curriculum year English Chinese language Math Chemistry

2016 1st r = 0.321 r = 0.021 r = 0.190 r = 0.249

p = .022 p = .886 p = .183 p = .078
2nd r = 0.257 r = 0.081 r = 0.220 r = 0.221
p = .069 p = .571 p = .120 p = .120
3rd r = 0.166 r = −0.052 r = 0.307 r = 0.147
p = .244 p = .716 p = .029 p = .303
4th r = 0.251 r = −0.035 r = 0.211 r = 0.015
p = .076 p = .810 p = .138 p = .917
Cumulative years 1–4 r = 0.279 r = 0.020 r = 0.255 r = 0.192
p = .047 p = .890 p = .071 p = .178
2017 1st r = 0.473 r = 0.056 r = 0.032 r = 0.137
p = .008 p = .768 p = .867 p = .471
2nd r = 0.366 r = 0.094 r = 0.012 r = 0.056
p = .004 p = .622 p = .951 p = .771
3rd r = 0.282 r = 0.005 r = 0.008 r = 0.232
p = .090 p = .980 p = .967 p = .218
4th r = 0.162 r = 0.031 r = 0.111 r = 0.288
p = .243 p = .870 p = .558 p = .123
Cumulative years 1–4 r = 0.397 r = 0.061 r = 0.038 r = 0.160
p = .030 p = .747 p = .841 p = .400
2018 1st r = 0.387 r = −0.069 r = −0.105 r = 0.068
p = .029 p = .707 p = .566 p = .712
2nd r = 0.058 r = −0.011 r = 0.089 r = 0.237
p = .752 p = .954 p = .627 p = .192
3rd r = −0.241 r = −0.106 r = 0.013 r = 0.161
p = .184 p = .563 p = .942 p = .380
4th r = 0.174 r = −0.004 r = −0.264 r = 0.154
p = .340 p = .982 p = .144 p = .400
Cumulative years 1–4 r = 0.190 r = −0.035 r = −0.028 r = 0.153
p = .298 p = .849 p = .879 p = .402

Such correlations had a trend of becoming weaker in following years' GPAs. However, for student's graduating in 2016 and 2017,
their cumulative GPA was still significantly correlated with their pre-admission English language exam scores (r = 0.279, p = .047;
r = 0.397, p = .030). English language scores were found to be more predictive of the first year's GPA than the following years.
Compared to English scores, mathematics scores were found to be significantly correlated with higher GPA scores (r = 0.307,
p = .029) of the third year in students graduating in 2016. When evaluating the secondary outcomes, Chinese language scores and
chemistry scores showed no significant correlation to cumulative GPA or any individual year in any of the three cohorts.
As summarized in Table 2, the relationship observed between gender and the primary outcomes was investigated, where the
significant correlations of cumulative GPA with English scores held true when assessing females only (r = 0.371, p = .009). The
statistically significant correlation was not observed in male students (r = 0.297, p = .053). When evaluating GPA by specific year,
significant correlations observed in male students were English scores with their first- or fourth-year GPAs whereas in female

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J.W. Tenney, et al. Currents in Pharmacy Teaching and Learning xxx (xxxx) xxx–xxx

Table 2
Correlation of preadmission exam scores with grade point average by gender.
Subject 1st year 2nd year 3rd year 4th year Cumulative years 1–4

Males
English r = 0.342 r = 0.324 r = 0.084 r = 0.275 r = 0.297
p = .009 p = .105 p = .532 p = .036 p = .053
Chinese language r = −0.059 r = 0.026 r = 0.007 r = 0.079 r = 0.057
p = .450 p = .593 p = .209 p = .574 p = .566
Math r = −0.101 r = 0.072 r = 0.167 r = 0.079 r = 0.212
p = .658 p = .848 p = .857 p = .557 p = .924
Chemistry r = 0.105 r = 0.038 r = 0.034 r = 0.123 r = 0.020
p = .433 p = .779 p = .802 p = .359 p = .628

Females
English r = 0.384 r = 0 0.300 r = 0.232 r = 0.317 r = 0.371
p = .004 p = .026 p = .089 p = .018 p = .009
Chinese language r = 0.108 r = 0.270 r = 0.133 r = 0.113 r = 0.142
p = .119 p = .048 p = .022 p = .113 p = .048
Math r = 0.213 r = 0.268 r = 0.309 r = 0.226 r = 0.192
p = .431 p = .046 p = .331 p = .411 p = .186
Chemistry r = 0.243 r = 0.266 r = 0.243 r = 0.051 r = 0.285
p = .730 p = .050 p = .074 p = .713 p = .059

students, English, Chinese and math pre-admission exam scores all had contributions to their performance on the back end of
pharmacy curriculum (Table 2). Moreover, the average preadmission English score for females was higher at 5.66 compared to males
at 5.43 (p = .042) along with higher average preadmission Chinese language score at 5.78 versus 5.25 (p = .038). The average
cumulative pharmacy school GPA for females was 3.25 versus 3.31 for male (p = .193).
Bonferroni correction, Holm correction and ANOVA with Tukey's approach were all investigated together with Spearman's test
with no significant correlation found, indicating correction which is possibly too strong for our current analyses.

Discussion

There is a current gap in literature regarding ESL students and predictors of success within post-secondary pharmacy schools
globally. To the best of our knowledge, our study is the first to investigate the relationship in pharmacy students between English
language performance scores and cumulative GPA within the Chinese speaking population. Previous studies have looked at different
outcomes in different medical professions such as dropout rate in nursing students.12
Primary outcome results indicate many positive correlations (Table 1) between pre-admission English performance scores and
cumulative GPA. For all three cohorts, the pre-admission English scores more strongly correlated with the first year GPA compared to
later years in the curriculum. This variation in correlation among the years of the pharmacy program could be due to students
becoming more comfortable to teachings in English over time due to longer exposure of English curriculum delivery, but also could be
due to the structure of the curriculum as communications is taught during their first year and classes with more heavy mathematics
components are taught in their second and third years. The pre-admission English score did not have a statistically significant
correlation with years three and four in any of the three cohorts. The cumulative GPA did have a statistically significant correlation in
two of the three cohorts. Efforts should be made to help ESL students adapt earlier to the English language curriculum delivery
including having communication skills courses earlier rather than later in the curriculum. None of the four exam subjects studied
showed significant correlation with the second year of the curriculum in any of the three cohorts.
When stratified by gender (Table 2), the correlation remains statistically significant for females for years one, two and four as well
as the cumulative GPA. This significance was not observed in males except in years one and four. This loss of significance in the
second year and in the cumulative GPA may potentially be due to the smaller sample size when the population of the study is divided
as such or that English language may be a greater predictor of academic success in females than in males. Females had higher English
and Chinese language preadmission scores as previously reported in the literature.15–19 This stronger correlation to academic success
for females compared to males is an interesting finding. Further research is warranted and would be needed before any definitive
explanation can be made for this finding.
The secondary objective of pre-admission mathematics scores was the only variable to have a significant correlation to cumulative
GPA (r = 0.307, p = .029), and this correlation was only seen in the third year of the curriculum for just one of the three cohorts.
Both Chinese language and chemistry provided no statistically significant correlation to pharmacy school GPA. These results indicate
that English language exam scores of ESL students correlates with their overall GPA in a pharmacy school where instruction is
completed in English. It may highlight the need to either raise the threshold for English performance scores to help improve GPA or
identify interventions for students with lower English performance scores to aid in achieving academic success. The association
between mathematics performance and the third academic year GPA may be due to the heavy mathematics component in that year's
curriculum with courses such as pharmacokinetics and biopharmaceutics.
Due to the lack of information from other studies with the same design, results from studies in medical and nursing students were
utilized to compare with our current study and similar trends were found. Higher English language performance scores generally

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J.W. Tenney, et al. Currents in Pharmacy Teaching and Learning xxx (xxxx) xxx–xxx

were associated with better academic performance measures in the first and second years of study in medical and nursing stu-
dents.7–12 Previous studies looked at populations likely with a native language of Farsi, Arabic, or completely unknown or mixed
native languages.7–12 The degree of difference of a language from English may have an impact on how easily English language skills
can be acquired throughout the curriculum. Currently, there is no quality data to support that higher English language scores would
be more important in Chinese language students than that of other native foreign languages. This would be an interesting area to
research going forward. When evaluating the data for university level students as a whole, there is an abundance of literature that has
produced variable and inconsistent results regarding English language performance and academic success at the undergraduate and
graduate levels.20 However, the applicability of this data to pharmacy students and other healthcare professional students is ques-
tionable due to the heavy usage of medical jargon and advanced communication skills required to be successful in the field of
pharmacy.
While the results are informative, there are some limitations of our current study. Though a statistically significant finding was
observed for the primary endpoint, we were unable to conduct a power calculation to detect differences for the outcomes. In addition
to what we assessed in this study, the other potential determinants of academic success that warrant evaluation include socio-
economic status, level of involvement in extracurricular activities, whether the students received any additional English language
training throughout pharmacy school, the overall Intelligence Quotient of the students, elective course selections, and age. Also, we
were unable to obtain the students secondary school grade GPA's. The specific population (only native Chinese speaking students) in a
post-secondary pharmacy school may limit generalizability to other populations of different native languages. Another potential
limitation is the HKDSE examination. There are more widely used and accepted English language performance tests such as the
International English Language Testing System (IELTS) or Test of English as a Foreign Language (TOEFL) that would be preferred
over the HKDSE. However, the HKDSE assesses English language performance in a similar manner to these other English language
performance (ELP) tests, and therefore these other ELP tests not required of our students. Lastly, while cumulative GPA may be an
important surrogate marker of academic success, a more practical relationship to consider is that between pre-admission English
language performance and professional success.
Further areas for potential research include conducting similar studies in future students to build a local database or add more
variables that may be related to academic success so that results are more robust. Globally, other institutions that instruct in the non-
native language of students could look for relationships between proficiency in language of instruction and cumulative GPA to draw
comparisons between populations. In addition, studies evaluating practices to help these ESL students perform better should be
conducted.

Conclusion

Pre-admission English exam scores in ESL pharmacy students demonstrated a stronger correlation with academic success than
mathematics, chemistry, or Chinese language. Based on our literature search, this is the first study of its kind in this population. These
findings regarding preadmission English scores and pharmacy school academic success were stronger in females than in males.
Further studies should be done to determine if these findings are reproducible and if English language performance impacts pro-
fessional success in addition to academic success.

Disclosure(s)

None.

Declaration of competing interest

None.

Appendix 1. Summary of bachelor of pharmacy curriculum

First year Communications

Public health & healthcare ethics
Introduction to pharmacy
Clinical microbiology & infection control
Fundamentals of pharmaceutical chemistry
Second year Biochemistry and molecular biology
Anatomy and physiology I, II
Pharmaceutical analysis
Dosage form science I, II
Pharmacology & therapeutics I
Principle of pharmaceutical dispensing
Fundamentals of herbal medicines

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J.W. Tenney, et al. Currents in Pharmacy Teaching and Learning xxx (xxxx) xxx–xxx

Third year Medicinal chemistry and drug design

Pharmaceutical product development and manufacturing
Biopharmaceutics and pharmacokinetics
Pharmacy law
Contemporary pharmacy practice
Pharmacology and therapeutics II, III
Electives
Fourth year Personal development in pharmacy
Community pharmacy practice
Pharmacology and therapeutics IV
Pharmacogenomics and pharmaceutical biotechnology
Complementary and alternative medicine
Research projects
Practice clerkships

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