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We have a large number of preceptors and between all of us we know a lot of people... Can't explain without giving details, but we've become pretty good at spotting an inflated CV. Also, you can figure out some of this by how the candidate responds to a question.
Ah, ok. I remember hearing about people lying on their apps for pharmacy school about their ECs. I thought people would know better once they're in pharmacy school and how easy it is to ask around and find the truth. I never got that pharmacy is a small world until I started applying to residencies and had people know my preceptors and letter writers personally. It's such a shame that people aren't above lying to get what they want...