Pharmacist’s Assessment of Student’s Part 4 CPPPerformance
Student: / Dates of Placement:Pharmacy:
Please complete all parts of this assessment of the student’s performance during their community pharmacy placement and return by email, fax or post to Pharmacy Placement Administration at the School of Pharmacy within two weeks of the student completing their placement:
Email: x: 09 3677192
Post: School of Pharmacy
Faculty of Medical and Health Sciences
The University of Auckland
Private Bag 92019
Auckland 1142
The supervising pharmacist’s assessment needs to include the student’s:
Level of preparation
Completion and application to assigned and required tasks.
A: Professional Behaviour Assessment.
Please tick the appropriate boxes for each of the 12 elements listed below.
Not at all or rarely / Some of the time / Most of the time / All the timeAppearance and dress conforms to professional and pharmacy standards.
Student is punctual and shows good time management i.e. arrives on time, meets deadlines for completion of tasks.
Student exhibits a positive attitude, a willingness to learn, and participates actively.
Student communicates accurately, concisely and confidently.
Student treats confidentiality issues appropriately.
Student is self-directed in undertaking tasks i.e. after initial instructions initiate’s activities to complete them.
7 / Student shows diplomacy and initiative with patients and staff.
8 / Student is respectful i.e. demonstrates regard for others, acts in a manner that shows recognition that he/she is a guest at the practice site as a professional student.
9 / Student is empathetic i.e. demonstrates appreciation of others’ positions and demonstrates consideration towards others.
10 / Student demonstrates accountability i.e. holds oneself liable for tasks/responsibilities, does not blame others for mistakes or mishaps.
11 / Student accepts and applies constructive feedback.
12 / Student behaves in an ethical manner and acts in accordance with the professions Code of Ethics.
B: Specific Task Performance
During the placement students had to complete a number of tasks. Using the criteria below, please allocate an achievement level for each of the tasks listed below.
Unsatisfactory / Satisfactory / MeritThe student displayed a poor interest or understanding of the tasks/activities and required considerable help and supervision. / The student consistently displayed appropriate interest and understanding of the tasks/activities and achieved them with minimal help and supervision. / The student displayed outstanding interest and understanding and performed all tasks/activities to the highest standard and displayed a level of ability beyond that expected.
Specific task / Circle appropriate achievement level / Comments
(Please elaborate on your choice)
Dispensed at least TWENTYprescription forms under supervision / Unsatisfactory / Satisfactory / Merit
Advised at least SIX customers on OTC products under supervision / Unsatisfactory / Satisfactory / Merit
Interviewed ONE patient and completed a medication review / Unsatisfactory / Satisfactory / Merit
Researched and documented ONE medicine information enquiry / Unsatisfactory / Satisfactory / Merit
Supervising pharmacist’s comments:
Supervisor’s name: / Supervisor’s signature:
2017Part 4 CPP Pharmacist Assessment Form