Welcome to today’s episode with our guest Ellie Twedt, a P4 at the University of Iowa College of Pharmacy, where we’re diving into a smarter, science-backed way to prepare for the NAPLEX while navigating your APPE rotations. Instead of cramming or waiting until the last minute, we’ll explore how to blend real-world learning with proven study techniques from Make It Stick: The Science of Successful Learning. This book highlights three powerful methods for long-term mastery—spaced practice, retrieval practice, and interleaving. We’ll focus especially on spaced practice and how it can transform your approach to studying.

Imagine using your RxPrep book not as a giant wall of content, but as a map. As you move through each APPE, you’ll connect the rotation experience to the RxPrep chapters that match what you’re seeing in the real world. This method turns APPEs into a natural structure for preparing for the NAPLEX, with built-in review and reinforcement along the way. We’ll talk about how to link chapters to rotations, create a rotation-based study schedule, and build habits that make your knowledge stick.

If you’ve ever felt overwhelmed by the sheer volume of material or wondered how to balance NAPLEX prep with the demands of your APPEs, this episode is for you. By the end, you’ll have a strategy that transforms studying from a last-minute scramble into a continuous, confident process—one that leverages both your rotations and the science of successful learning.

You can find the free materials she talks about in the interview under "Free General Resources" here:

https://residency.teachable.com/p/extremeloi

Auto Generated Transcript 

Hey, welcome to the Pharmacy Residency Podcast. I haven't podcasted in a while, but we've got 500 episodes that you can use as a reference—they're all still out there. We've had a bit of an issue with the NAPLEX, and I think this year presents a real opportunity. This year and next will be, if not the easiest times to get a residency, certainly times with significantly fewer applicants—around 2,000 fewer graduates in each class. One of the best ways to stand out is to show that you're going to pass the NAPLEX, or at least that you're seriously preparing to give it your best shot.

So, I've brought on Ellie Twedt from the University of Iowa. She's a P4 in her second rotation, right? Yep, second rotation. We've asked ourselves: how can we ensure we're putting our best foot forward? We're taking a page out of the book Make It Stick: The Science of Successful Learning. One lesson in there is that spaced practice—essentially, not cramming at the end—is critical. When the NAPLEX rolls around, you don't want to be eight or nine months removed from studying and suddenly find yourself panicking. Unfortunately, that happens often.

We’ve got some solutions, and Ellie is here to walk us through them. Ellie, tell us a little about yourself—how you got into pharmacy school and Iowa specifically.

Ellie: Yeah, as Tony mentioned, I’m a P4 at the University of Iowa College of Pharmacy. I came to pharmacy through an untraditional path—starting with veterinary medicine. I found I loved both the drug side of things and working with people, so pharmacy felt like the perfect marriage. Being an in-state student, Iowa made sense, and it also gave me the chance to continue my cross country career. It’s been a great fit, and I’ve really enjoyed my time here.

Tony: So you started at Iowa and stayed there. I married into Iowa—that’s how I ended up here. Let’s shift to talking about NAPLEX pass rates. They’ve gone down significantly. We’re not here to blame anyone, but rather to ask: what can we do about it?

When I was in school, the PharmD was in its first year at Maryland. If I had finished my pre-pharmacy work in two years—some call it “two years of pre-pharmacy”—I could’ve gone straight into three years of pharmacy school. I did mine in three years. So I would’ve done three years at the University of Maryland at Baltimore (now University of Maryland, Baltimore). APPEs were only in the final semester: four or five weeks in retail, four to five in hospital, and one elective. That was it. There wasn’t much of a gap between finishing classes and taking the NAPLEX.

I graduated in 1996—nearly 30 years ago. It wasn’t as easy as choosing between aspirin and Tylenol, but it was simpler. Over the years, complexity has increased—residencies, PGY2s, fellowships, infectious disease, oncology, etc. The exam has grown more challenging. And while you’re not allowed to talk about the NAPLEX after taking it, we hear stories: someone gets an all-oncology version, someone else all HIV or cardiology.

Today, students might go 15 to 16 months between finishing didactic work and sitting for the NAPLEX. That’s a long gap. You P3s have APPEs that start during your third year, so depending on your schedule, it could be a long stretch between classroom learning and the exam.

Ellie, what’s your solution to that gap? And how are you using spaced practice?

Ellie: I just got my enormous RxPrep book—over 1,000 pages. My question was: how can I break this up to make it less overwhelming and use my time wisely? I’m trying to match chapters to my APPEs so I’m walking into each one more prepared.

Tony: And it’s even harder now because the questions aren’t in the book anymore. That’s another $500.

Ellie: Exactly. The content is so big it doesn’t fit in one book. So now I read a chapter bit by bit, watch lecture videos for concepts I don’t remember, then end with practice questions. That’s part of the retrieval practice from Make It Stick.

Tony: Right—trying to recall things helps solidify learning. And it looks great to your preceptor. You make a good first impression if you’ve reviewed guidelines and identified knowledge gaps beforehand. Instead of asking for help with major gaps two days before the rotation ends, it’s better to start strong.

Tell us how you matched chapters to your first APPE and beyond.

Ellie: My first was a community clinical rotation, so I assigned myself chapters on compounding, non-sterile calculations, OTC counseling (allergic rhinitis, tobacco cessation, dietary supplements, etc.). I also drew on my work experience at a compounding pharmacy—placing that content early gave me time for harder chapters later.

Tony: Are you getting into a rhythm now? Some people start with questions first to identify knowledge gaps.

Ellie: I got both the book and online content. I try to read a bit, then watch videos if I get stuck, and then do test questions to reinforce the concepts.

Tony: That makes sense. You’re combining spaced and retrieval practice. Also, your preceptors don’t have a packet of your history—they only know you’re supposed to be prepared. Showing initiative and acknowledging gaps helps them help you.

Now, you’re in your academic block, which gives you more time. What chapters did you assign yourself?

Ellie: I’m using this time to cover foundational science—lab values, drug references, etc.—that will set me up for acute care and ambulatory care later. I’m also catching up on any chapters I didn’t get to.

Tony: Great. What’s your next APPE?

Ellie: I’m heading to Amber Pharmacy in Omaha—a specialty rotation focused on hepatitis C, oncology, MS, and Crohn’s. I assigned myself chapters on liver disease, transplant, cystic fibrosis, and sickle cell.

Tony: Oncology is always a beast. Just know your limits—don't try to impress a BCOP with guesses. It’s better to say what you do and don’t know. Next rotation?

Ellie: Acute care at Gundersen Lutheran in La Crosse, Wisconsin. I focused on more acute chapters—things I haven’t covered yet but need to know.

Tony: Makes sense. Did your preceptors give you guidance on which chapters to prioritize?

Ellie: Yes, and I tried to be strategic—less time in heavier blocks, more content when I have flexibility.

Tony: Next?

Ellie: Infectious disease in Iowa City. I already did the ID elective, so I’m reviewing those chapters again, plus HIV and drug allergy.

Tony: HIV can get really deep. Are you planning to take a practice NAPLEX?

Ellie: Possibly. It might help assess whether I’m on track.

Tony: Agreed. Okay, what’s next?

Ellie: Ambulatory care in Sioux City at a family medicine clinic—focusing on chronic disease and neurology. Also spacing out some community chapters.

Tony: You’ll probably be doing MTMs. Those can be a grind.

Ellie: Yeah, calling patients who don’t want to be called... fun times.

Tony: After that?

Ellie: An elective pharmacy rotation at One Arrow Rx in West Des Moines—they serve Metacap facilities and offer clinical services. I put more community topics there to balance the load.

Tony: Final rotation?

Ellie: My hospital rotation at Mary Greeley in Ames.

Tony: So you’ll finish with inpatient. That’s great. You mentioned challenges—what were the biggest ones in making your schedule?

Ellie: First, assigning chapters to my most specific rotations helped narrow things down. Then I realized RxPrep lists estimated study times for each chapter, which I hadn’t considered. I’d go back and balance chapter hours more evenly across blocks if I had to revise.

Tony: You’re being hard on yourself. Just having this mapped out is a huge win. Final thoughts?

Ellie: Nope, I think we covered everything. Thanks for having me.

Tony: Thanks for being on the Pharmacy Residency Podcast!

TLDR: Skip the grief process for now, take on Phase II, and email me if you want some quick advice [email protected] 

Here’s a list of the top reasons students get turned down for pharmacy residency programs, not necessarily ordered by most common to least common based on why you in particular did not match:

1. Weak or Unfocused Letters of Intent A poorly written or generic letter of intent is one of the most common reasons candidates are overlooked. Programs want to see clear, specific reasons for your interest in their residency and how your experiences align.

2. Poor Interview Performance Even strong candidates can falter in interviews if they fail to communicate their skills, goals, and personality effectively.

3. Inadequate Clinical Experience Limited exposure to diverse rotations or insufficient patient care experience can make you seem unprepared for the demands of a residency.

4. Weak CV or Resume Even with solid experience, a poorly formatted CV or lack of emphasis on accomplishments can weaken your application.

5. Lack of Strong References or a Poor Recommendation Residency directors heavily rely on references. If your letters are vague or uninspiring, it can raise concerns about your performance or professionalism.

6. Poor Professionalism or Attitude Residency directors look for candidates who are adaptable, humble, and collaborative. Arrogance, lack of teamwork, or failing to follow up can severely hurt your chances.

7. Low or Unbalanced GPA While GPA isn’t always a dealbreaker, a poor academic record may suggest you’ll struggle with the demands of residency.

8. Limited Leadership and Involvement Programs often seek candidates who demonstrate initiative, collaboration, and leadership through involvement in student organizations or volunteer work.

9. Weak Research or Project Involvement While research experience isn't always mandatory, a lack of engagement in presentations, posters, or projects can make your application less competitive.

10. Not Ranking Programs Strategically This mistake is common but avoidable. Candidates may undermine themselves by ranking too few programs or focusing only on highly competitive sites without backup options.

Key Takeaway: Focus most on crafting a compelling letter of intent, preparing thoroughly for interviews, and maximizing clinical experience. Strengthen your CV, build strong mentor relationships for references, and demonstrate professionalism throughout the process, but get back on the horse and start emailing programs . . . now. 

Here's the website for the Interview Materials https://residency.teachable.com/p/interview

1. Research the Program

   Dive deep into the residency program's structure, goals, and key rotations. Understand their mission statement and identify what makes them unique. This will help you tailor your responses and show genuine interest. Use the Excel file to match your APPEs to other residency rotations and offerings. Make sure you talk about PGY-2 if it's available. 

2. Review Your Application

   Familiarize yourself with your CV and personal statement. Be prepared to discuss any experiences or projects you mentioned in detail. Highlight your achievements and how they align with the program’s strengths. Again, it's the match, don't highlight your achievements as look at what I did, but look at how we are similar. 

3. Practice Behavioral Questions

   Expect questions like, “Tell me about a time you overcame a challenge.” Use the STAR method (Situation, Task, Action, Result) to structure your answers clearly and concisely. There is much more detail in the course about the ROCK STAR and RACE START questions and answers, you can also use those techniques on the supplemental questions. 

4. Prepare Questions for Them

   Thoughtful questions show interest and engagement. Ask about mentorship opportunities, unique rotations, or the program’s approach to professional development. Avoid questions you could easily find online. The best questions keep the conversation going. 

5. Brush Up on Clinical Knowledge

   Be ready to answer clinical scenarios or demonstrate your thought process in solving problems. Review key disease states, drug interactions, and treatment guidelines relevant to the program's focus. You can find the list of links to TLDR clinical reviews here: https://residency.teachable.com/p/interview

I just wanted to remind you that I’m still offering one-on-one help with letters of intent for residency applications. If you’d like to work with me, simply head to residency.teachable.com. Look for the interview course, sign up there, and then email me your letter of intent.

Make sure your letter is addressed and formatted according to the template provided in the free LOI course to your top choice. Include as much detail as possible—aiming for a page and a half is better than a single page because it’s always easier to trim content than to add more later.

When you send your email, I’ll also ask for some additional information, like your CV and a link to the program you’re applying to. I typically complete reviews within 24 hours, so don’t worry if your deadlines are coming up. I’ll make sure you’re all set.

The first letter review also comes with a template that can help you efficiently create the other 10 to 12 letters you might need for the remaining programs you're applying to.

Applying for a residency program can be overwhelming, especially when critical documents like letters of recommendation are delayed. These letters are vital as they provide insights into your skills, work ethic, and potential as a future clinician. If you’re facing the challenge of a late recommendation, don’t panic. Here’s how to navigate this situation effectively:

1. Stay Calm and Assess the Situation

   Determine who the recommender is, when they committed to submitting the letter, and how late the recommendation is. Understanding these details will help you plan your next steps.

2. Follow Up Politely

   Life happens, and delays are sometimes unavoidable. Send a polite reminder to your recommender, either via email or phone, and offer to provide any additional information or assistance.

3. Use Multiple Communication Channels

   If email doesn’t prompt a response, consider calling or stopping by their office, if appropriate, to follow up.

4. Notify Your Program Coordinator

   If the deadline is approaching, inform your program coordinator. Many application systems, like PhORCAS, allow for late submissions of recommendation letters and transcripts as long as the rest of your application is complete.

5. Have a Backup Plan

   If your primary recommender cannot provide the letter, identify an alternative who can write a strong letter on short notice.

6. Remain Professional

   Avoid expressing frustration or anger. Maintain professionalism, as your recommender is helping you by writing the letter.

7. Plan for the Future

   Request letters well in advance, provide clear instructions, and set internal deadlines to avoid similar issues in the future.

You can handle a late recommendation with professionalism and grace by following these steps. Residency programs value applicants who demonstrate resourcefulness and composure in challenging situations.

Your academic transcript is another essential part of your residency application, providing programs with a record of your academic performance. If you discover that your transcript will be delayed, here’s how to address the issue:

1. Contact Your Registrar Immediately

   Reach out to your school’s registrar to understand the cause of the delay and inquire about expedited options, such as rush processing or electronic submission.

2. Inform the Residency Programs

   Notify the residency programs about the delay and provide them with an estimated timeline for when the transcript will arrive.

3. Provide Temporary Documentation

   If possible, submit an unofficial transcript as a temporary measure until the official document is available.

4. Use Expedited Shipping

   If the issue is related to mailing, explore expedited shipping options like FedEx to speed up delivery.

5. Check Platform Policies

   Review the application platform’s policies. Many systems allow applicants to submit incomplete applications initially, with delayed documents added later.

6. Plan Ahead

   Request transcripts as early as possible, confirm receipt with the application platform and ensure all outstanding fees are paid to avoid delays.

Managing a late transcript requires clear communication and proactive measures. By keeping programs informed and exploring temporary solutions, you can minimize the impact of the delay.

Both late recommendations and late transcripts can be stressful, but they are opportunities to demonstrate your ability to handle unexpected challenges—an essential skill for any future resident.

I just wanted to remind you that I’m still offering one-on-one help with letters of intent for residency applications. If you’d like to work with me, simply head to residency.teachable.com. Look for the interview course, sign up there, and then email me your letter of intent.

Make sure your letter is addressed and formatted according to the template provided in the free LOI course. Include as much detail as possible—aiming for a page and a half is better than a single page because it’s always easier to trim content than to add more later.

When you send your email, I’ll also ask for some additional information, like your CV and a link to the program you’re applying to. I typically complete reviews within 24 to 48 hours, so don’t worry if your deadlines are coming up. I’ll make sure you’re all set.

The first letter review also comes with a template that can help you efficiently create the other 10 to 12 letters you might need for the remaining programs you're applying to.

One quick tip: don’t limit yourself to just applying to four programs because of financial constraints. While budgets can be tight, applying to too few sites often limits your opportunities. Find a way to maximize your applications—it can make a huge difference.

If you have any questions, feel free to email me at [email protected]. Again, I can turn your letter around in 24 to 48 hours, so deadlines are no problem.

Thanks for listening, and I’m here to help you succeed!

Free Residency Application DIY Course https://residency.teachable.com/

• Research programs thoroughly before arriving.
• Understand each program's unique features and align them with your career goals.
• Prepare a succinct, engaging "elevator pitch" to introduce yourself to program representatives, but stop talking an listen after 

• Ensure your CV is tailored, error-free, and professional.
• Bring plenty of printed copies and have a digital version ready to share (you probably won't use them, but it's good to be prepared with what you have done) 

• Attend showcase events and take the initiative to introduce yourself to preceptors and residents, but focus on residents! 
• Engage in meaningful conversations, showing genuine interest in the program.
• Follow up promptly with thank-you emails to reinforce your impression if you met someone and know their name and have something more you want to know 

• Practice common and behavioral interview questions, highlighting your clinical experiences and problem-solving skills.
• Be ready to discuss specific cases, rotations, and how they prepared you for a residency.
• Ask insightful questions to demonstrate your interest and commitment to the program.

• Keep a positive mindset throughout the conference.
• Plan breaks to avoid burnout and maintain your energy.
• Stay organized with a schedule of key events and prioritized program visits.

• Use Midyear as a networking opportunity beyond just the residency showcase.
• Connect with peers, mentors, and professionals to expand your support network.
• Keep track of contacts and continue nurturing those relationships post-conference.

This podcast equips listeners with the tools they need to navigate the ASHP Midyear with confidence and professionalism, helping you maximize the chances of landing your ideal residency. Tune in to learn how preparation, networking, and resilience can make all the difference!

Free  DIY Residency Prep Course Link: https://residency.teachable.com/

Coupon Code: MEMORIZING2024

If you want my one-on-one help with the LOI, sign up for the Residency LOI One-on-One Help and Interview Course and send your LOI to me at [email protected] for revision. 

In this episode, we break down a Residency Application Rubric to help you assess your strengths, identify gaps, and build a winning pharmacy residency application. From GPA and clinical rotations to leadership roles and community service, we’ll guide you on how to prioritize and rank your experiences effectively. Whether you’re just starting or polishing up your final submission, this episode gives you the tools you need to feel confident and prepared. Tune in and make sure you’re on track to land your dream residency. 

$95 dollar coupon is MEMORIZING2024 (all caps) 

In this episode, I give my general recommendations for the residency process and give you the free code above for the Extreme LOI/Cover Makeover course focuses on crafting standout Letters of Intent (LOI) for pharmacy residency applications.

It includes templates, video guides, and editing assistance to refine LOIs, emphasizing clarity and professionalism. The course also covers CV writing and interview prep to help candidates increase their match success. Participants can access resources for a year. If you are interested in working one-on-one with me for LOI editing and revision, email me at [email protected] 

For more details, and to use the coupon visit the course page.

The Extreme LOI/Cover Makeover course is divided into 12 key sections, focusing on:

1. Personal branding and writing style,
2. Structuring a compelling LOI,
3. Identifying residency goals,
4. Tailoring LOIs to programs,
5. Highlighting skills and experiences,
6. Demonstrating fit with specific programs,
7. CV writing tips,
8. Common application errors to avoid,
9. Personal statement guidance,
10. Interview prep,
11. Finalizing documents, and
12. Editing assistance and review options.

Each section aims to improve LOI quality for a stronger residency application. 

In this multi-part series we're going to start looking at what makes residency applications stand out. One of the wow moments, is if you have your name as an author on a peer-reviewed publication, but there are other reasons to publish as well, including finding where your area of specialty is. Want to work with me one-on-one on your letter of intent, you can find some free resources here to get started. https://residency.teachable.com/ 

The lack of urgency with preparing for the NAPLEX and MPJE always bothered me. It's like here's the one thing that if you don't pass, you don't work, and students are completing APPE requirements instead of getting deep into their preparation. In this episode, I talk about how NAPLEX pass rates which were in the high 90s in 2009 are now in the high 70s. Only 1554 students last year graduated from a school of pharmacy with a pass rate in the 90s. Make sure you prepare early and often for the NAPLEX. I reference a pharmacology review course here: https://residency.teachable.com/p/mobile and that TLDRPharmacy has some great MPJE materials.