Developing an inclusive pharmacy assessment design is essential for ensuring that faculty evaluate students on their clinical knowledge rather than their English proficiency. A recent study by Greene et al. investigated the prevalence of Tier 2 vocabulary in faculty-developed pharmacy examinations. These words, which often possess multiple meanings across different contexts, frequently pose significant challenges for multilingual learners (MLs). Specifically, researchers categorized 40% of the most frequent words used in these assessments as Tier 2. Consequently, students with lower reading comprehension may struggle to interpret questions accurately, even if they possess the requisite clinical skills.

Tier 2 vocabulary includes high-frequency words such as \"risk, scenarios, treatment,\" and \"appropriate.\" While these terms appear often in mature academic language, their semantic variability can create unnecessary confusion during high-stakes exams. For instance, the word \"appropriate\" might imply adherence to clinical guidelines in one scenario but social conduct in another. In contrast, Tier 3 words are highly specific to the discipline, such as \"pharmacokinetics,\" and educators typically teach them directly within the curriculum. Therefore, the unintentional use of complex Tier 2 language can inadvertently create barriers to equity in health professions education.

Strategies for Inclusive Pharmacy Assessment Design

To address these linguistic barriers, faculty members should adopt specific pedagogical tools and frameworks. Universal Design for Learning (UDL) principles provide a robust foundation for creating accessible assessments that benefit all students. Furthermore, educators can incorporate vocabulary review tools and comprehensive glossaries to clarify potentially ambiguous terms. Additionally, systematic item-writing training helps faculty recognize and minimize the use of problematic Tier 2 words. This proactive approach ensures that the assessment remains valid and fair, regardless of a student's linguistic background.

Future research should focus on the direct correlation between Tier 2 word frequency and student performance across diverse settings. Moreover, expanding these investigations into international programs will provide a broader understanding of language equity in medical education. Ultimately, refining the language of assessment is a critical step toward fostering a more diverse and capable global healthcare workforce.

Frequently Asked Questions

What are Tier 2 vocabulary words in a medical context?

Tier 2 words are high-frequency terms that carry different meanings depending on the context. In medical education, examples include \"risk,\" \"significant,\" or \"appropriate,\" which may vary in nuance between clinical, social, and statistical scenarios.

How does complex vocabulary affect exam validity?

When an assessment uses overly complex or ambiguous vocabulary, it may unintentionally measure a student's language proficiency instead of their subject knowledge. This creates \"construct-irrelevant variance,\" which can lower the overall validity of the exam results.

What is the role of Universal Design for Learning (UDL) in assessments?

UDL aims to provide multiple ways for students to access information and demonstrate their understanding. In the context of assessments, this involves using clear language, providing glossaries, and removing unnecessary linguistic barriers to ensure fair evaluation.

Disclaimer: This content is for informational and educational purposes only. It does not constitute medical advice or professional training. Refer to the latest local and national guidelines for clinical practice.

References

Greene E et al. Examining Tier 2 vocabulary in pharmacy assessments: Implications for inclusive design. Curr Pharm Teach Learn. 2026 May 14. doi: undefined. PMID: 42134032.

Aulakh R. Designing for Diversity: Integrating Universal Design for Learning in Medical Education. Adv Res Pub. 2026.

Rosario N, Arif S. Universal Design for Learning and the Ability Spectrum: Strategies to Diversify Your Teaching. AACP Institute for Inclusive Excellence. 2025.