CAMPBELL UNIVERSITY COLLEGE OF PHARMACY & HEALTH SCIENCES

Advanced Pharmacy Practice Experience Student Evaluation Form __ Patient Care Rotation

General overview -

For Part I of this Evaluation:

Preceptors should select the option that best describes the students performance for each of the items listed for the seven goals noted in Part I of this evaluation. Please read each category carefully. The language used to define student performance changes based on the item being assessed. Supporting comments should be entered in the appropriate comment fields.

For Part II of this evaluation:

Preceptors should give the student at least two site-specific assignments for a grade. The total number of points for all assignments should equal 20 points. The preceptors may weight the assignments differently; however, the total number of points must equal 20 points. [For example: the student may have a journal club (max allowable points = 5) drug monograph (max allowable points = 5), and a case presentation (max allowable points = 10).] The preceptor will enter the number of points obtained and then state the maximum allowable points for each assignment in Part II of this evaluation.

Part I Goal 1: The student demonstrates an acceptable level of professional maturity. (5% of Total Evaluation)

Professionalism

  1. Overall poor attitudeORwears unacceptable attireORdoes not respect patient confidentiality or site rulesORexhibits frequent negative interaction with co-workers.
  2. Somewhat poor attitudeORinfrequent negative interaction with co-workers and/or patients;OROccasional inappropriate dress; Maintains patient confidentiality.
  3. Generally good attitude and positive interaction with most co-workers. Dresses appropriately. Maintains patient confidentiality; occasionally handled patient concerns in a nonprofessional manner.
  4. Overall good attitude and positive interaction with coworkers and patients. Dresses appropriately and maintains patient confidentiality.
  5. Very professional attitude, interacts well with all co-workers and patients. Dresses appropriately. Respects patient confidentiality. Typically goes beyond what is necessary to assist co-workers and patients.

Participation as a member of the health-care team

  1. Consistently observes only; often appears to avoid participation
  2. Has difficulty establishing relationships; avoids sensitive or difficult/complex situations
  3. Establishes adequate relationships; participates if directed
  4. Establishes good relationships; actively participates; team player
  5. Establishes working relationships and proactively participates as an integral team member; appropriately assertive

Part I Goal 2: The student demonstrates appropriate initiative regarding rotation activities & assignments. (5% of Total Evaluation)

Motivation

  1. Speaks and acts on requests only; avoids asking questions and avoids participation
  2. Does not really exhibit self-motivation, but does complete work with significant prompting and direction by the preceptor, infrequently asks questions
  3. Limited self-motivation, completes work but generally does not ask questions or seek additional ways to contribute
  4. Generally motivated completes work with minimal direction and occasionally inquires or seeks additional ways to contribute
  5. Very motivated; completes work with minimal direction; consistently takes initiative and seeks out ways to contribute; asks thoughtful questions; inquisitive/eager to learn

Organization & Time Management

  1. Consistently disorganized and unprepared
  2. Occasionally disorganized and unprepared; struggles with time management
  3. Usually organized, but occasionally unable to retrieve information; exhibits adequate time management skills
  4. Organized, can retrieve information easily; exhibits good time management skills
  5. Well-organized with all information readily retrievable; exhibits excellent time management skills, including using spare time wisely

Part I Goal 3: The student exhibits responsibility and dependability regarding rotation activities. (5% of Total Evaluation)

Responsibility

  1. Avoids responsibility; avoids tasks; ignores obvious issues; does not follow through requests
  2. Assumes responsibility for selected issues; infrequently examines issues carefully; fails to follow through on some requests
  3. Appropriately assumes responsibility; most often examines issues carefully; usually follows through on requests
  4. Appropriately assumes responsibility; examines issues carefully; asks for help when necessary; follows through on requests
  5. Assists when needed without being asked; aware of limitations takes responsibility for self-learning; consistently examines issues carefully; follow through on all requests (includes appropriate follow up)

Punctuality (meeting deadlines and attendance)

  1. Failed to meet many deadlinesORone unexcused absenceORconsistently tardy
  2. Missed an important deadline or several activities not completed in a timely manner;ORoccasionally tardy
  3. Regularly met all deadlines but did have an instance of tardiness
  4. Regularly attended all patient care activities and completed all projects on time
  5. Always on time (if not early) for patient care activities. Consistently demonstrated planning and often completed assignments in advance of the deadline

Part I Goal 4: The student demonstrates the ability to conduct systematic, efficient, and thorough retrieval and interpretation of appropriate patient/medical information, drug information, and medical literature. (10% of Total Evaluation)

Data Collection

  1. Consistently fails to obtain proper information from proper sources
  2. Collects some data, but omits several fundamental details
  3. Collects obvious data, but usually does not collect proper details
  4. Usually collects obvious and detailed data from proper sources
  5. Effectively obtains complete data for each problem using a variety of sources

Drug information & literature retrieval

  1. Consistently fails to perform a systematic search; fails to identify appropriate resources; misses fundamental information often
  2. Struggles to perform a systematic search and/or sometimes fails to identify appropriate resources; at times misses fundamental information
  3. Usually performs a systematic search and identifies appropriate resources most of the time; generally obtains fundamental information but omits pertinent more comprehensive details
  4. Performs a systematic search and identifies appropriate resources most of the time; always obtains fundamental information and is at times capable of retrieving pertinent comprehensive details
  5. Performs systematic search and identifies appropriate resources; effectively uses a variety of sources; always obtains fundamental information and generally includes pertinent comprehensive details

Literature evaluation

  1. Unable to evaluate medical literature
  2. Sometimes able to evaluate medical literature
  3. Usually able to evaluate medical literature; but has difficulty with relevance & application (requires multi-question prompting to convey application or importance in practice.)
  4. Usually able to evaluate literature with moderate depth; and is often capable of explaining application in practice w/minimal prompting
  5. Able to evaluate literature with sophistication and depth and generally is capable of explaining application in practice w/o preceptor intervention

Part I Goal 5: The student will demonstrate an understanding of pharmacotherapy. (20% of Total Evaluation)

Pathophysiology of disease

  1. Major deficits in knowledge and retention of basic principles of common disease states; significant difficulty or inability to assimilate new information
  2. Usually unable to explain basic principles of common disease states, and only very infrequently capable of incorporating details beyond the fundamental elements; some difficulty with assimilating new information
  3. Able to explain basic principles with relative consistency; is occasionally capable of incorporating details beyond the fundamental elements; typically requires prompting by preceptor to demonstrate assimilation of new information
  4. Able to explain principles & details with moderate depth; occasionally requires prompting by the preceptor
  5. Able to explain principles and details with sophistication and depth with no intervention; knowledge-base consistently exceeds expectations

Pharmacologic and pharmacokinetic principles

  1. Major deficits in knowledge and retention of mechanisms of actions, pharmacokinetic principles and adverse effects for common therapies and drug classes; significant difficulty or inability to assimilate new information
  2. Usually unable to explain mechanisms of action, pharmacokinetic principles and adverse effects for common therapies and drug classes; some difficulty with assimilating new information
  3. Able to explain mechanisms of action, pharmacokinetic principles and adverse effects for common therapies and drug classes with relative consistency; typically requires prompting by preceptor to demonstrate assimilation of new information
  4. Able to explain mechanisms of action, pharmacokinetic principles and adverse effects with moderate depth for common therapies; occasionally requires prompting by the preceptor.
  5. Able to explain mechanisms of action, pharmacokinetic principles and adverse effects for common therapies and drug classes with sophistication and depth with no intervention; knowledge-base consistently exceeds expectations

Medication history and regimen review

  1. Major deficits in obtaining medication history for assigned patients and/or in determining the rationale or justification for the patients' therapies; often unable to complete this task
  2. Usually unable to obtain basic medication history for assigned patients and/or struggles to determine the rationale or justification for the patients' therapies; sometimes is not able to complete this task for assigned patients
  3. Able to obtain patients' medication history but typically seeks assistance from the healthcare team in understanding the rationale for various therapies
  4. Able to obtain patients' complete medication history, review and explain rationale (or lack of rationale) for therapies with infrequent intervention or prompting
  5. Able to obtain patients' complete medication history, review and explain rationale (or lack of rationale) for therapies with no intervention

Part I Goal 6: The student is able to identify medication-related problems, establish appropriate medication treatment goals, and can design an individualized treatment plan. (20% of Total Evaluation)

Utilize and interpret laboratory tests

  1. Major deficits exist; poor understanding of laboratory ranges, appropriate rationale and timing for common laboratory tests; misinterpretation of lab results occurred regularly; significant difficulties understanding the utility and application of the results
  2. Exhibits some difficulty in knowing what test to obtain and/or the timing for the test; occasionally struggles with knowledge of normal values for common laboratory tests; infrequent misinterpretation of lab results
  3. Able to interpret and analyze common laboratory tests; familiar with normal range, rationale and timing for ordering specific tests and can manage laboratory data for patients with occasional prompting or intervention from the preceptor
  4. Able to interpret and analyze common laboratory tests with infrequent intervention; familiar with normal range, rationale and optimal timing for utilizing specific laboratory tests
  5. Able to interpret and analyze common laboratory tests with no intervention; able to utilize normal range, recognize lab error, understand rationale and optimal timing for ordering specific tests and can apply results appropriately

Problem identification

  1. Unable to identify basic problems in a patient or situation
  2. Usually unable to identify basic problems; unable to prioritize problems
  3. Able to identify basic problems; occasionally able to prioritize problems
  4. Able to identify basic problems and occasionally complex issues; typically able to prioritize problems
  5. Able to identify basic and complex problems; correctly prioritize problems and provide rationale

Therapeutic planning

  1. Unable to appropriately formulate an optimal therapeutic plan; plans commonly have inappropriate therapies and/or incorrect doses. No or infrequent evidence-based medicine approaches considered
  2. Typically struggles to formulate an optimal therapeutic plan. Plans are generally not complete. Recommendations may not be appropriate based on the patient. Student may be unable to provide rationale for therapy even though the intervention is appropriate. Recommendations are usually not supported.
  3. Usually capable of formulating an optimal plan, but therapeutic plans are not always complete in that plans may not be problem or patient specific. Usually selects proper interventions; alternatives are generally nonexistent; recommendations may not be optimally supported
  4. Able to design an optimal (individualized & appropriate) therapeutic plan (nonpharmacologic & pharmacologic) with infrequent intervention; generally uses evidence-based medicine; has difficulty with alternative plans
  5. Able to design an optimal (individualized & appropriate) therapeutic plan (nonpharmacologic & pharmacologic) with rare intervention and sophistication and generally includes alternative plans, uses document evidence-based medicine

Part I Goal 7a: The student displays appropriate verbal and written communication skills and is receptive to feedback. (12% of Total Evaluation)

Verbal communication with preceptor and other healthcare professionals

  1. Appears arrogant; uses unclear language, incorrect information, offensive tone, slang or cursing; insensitive to surroundings
  2. Impersonal and abrupt; generally provides correct information; usually uses correct language; does not always respect surroundings
  3. Occasionally maintains proactive dialogue; provides correct information; usually uses clear and correct language and; usually respectful of surroundings
  4. Maintains good proactive dialogue exhibits good active listening skills; provides correct information and language and is respectful of surroundings
  5. Always utilizes proactive dialogue; exhibits excellent active listening skills; always provides correct information; always uses clear and correct language; always respectful of surroundings

Written Communication

  1. Assignments inarticulate and with unacceptable grammatical spelling and organizational errors; work poorly cited
  2. Assignments generally inarticulate with some organizational, grammatical or spelling errors; work poorly cited
  3. Well-cited information; rare grammatical or spelling error
  4. Well-cited information with articulation; no grammatical or spelling errors
  5. Critically presented, well cited information with articulation, clarity and insight, free of grammatical or spelling errors

Patient interview and counseling skills

  1. Disorganized; uses unclear language, incorrect information, offensive tone, slang or cursing; insensitive; does not assess patient level of understanding; relies on preceptor
  2. Impersonal and abrupt; generally provides correct information; unorganized; occasional use of unclear or inappropriate terminology; sensitive to patient needs; usually provides information at appropriate level for patient; often requires preceptor intervention
  3. Maintains a good dialogue; provides effective counseling; but does not always obtain all relevant information from the patient; sensitive to patient needs; provides information at appropriate level for the patient; but requires some preceptor intervention
  4. Directs conversation; allows patients to easily provide or receive information; uses expressive gestures to emphasize points to emphasize points; sensitive to patient needs; provides information at appropriate level for the patient; requires little preceptor intervention
  5. Engages in dialogue, speaks clearly and uses appropriate level and correct language; uses active listening skills; interprets nonverbal clues; sensitive to patient needs; directs the conversation while still managing to recognize new information from the patient; explains rationale for treatment and ensures patients understanding

Acceptance and utilization of feedback

  1. Makes excuses; displaces blame; resists feedback; appears defensive
  2. Listens to feedback without acknowledging error or room for improvement; does not incorporate feedback; does not seek feedback
  3. Listens to feedback; acknowledges errors and room for improvement; attempts to incorporate feedback; does not seek feedback
  4. Handles feedback well and generally incorporates feedback; but does not consistently seek feedback
  5. Self-evaluates; seeks out constructive feedback; handles feedback constructively and consistently incorporates feedback

Part I Goal 7b: The student displays appropriate verbal and written communication skills and is receptive to feedback. (3% of Total Evaluation)

Medical notes (egs., SOAP, FARM, pharmacokinetic note)

  1. Disorganized; frequently omits basic and pertinent information; very difficult to understand and follow; does not understand relevant vs. irrelevant information; uses first person; note appears biased
  2. Occasionally unorganized; often difficult to understand and follow; provides irrelevant details (requires significant feedback/input from preceptor to complete appropriate note)
  3. Generally organized and focused; but note is not as thorough as should be; avoids bias; (typically requires feedback from preceptor to produce an appropriate note)
  4. Organized; summarizes information appropriately; but occasionally omits pertinent information; avoids bias (moderate to minimal feedback required by preceptor)
  5. Completely organized; includes all pertinent information; follows logical sequence; thorough yet concise; avoids bias (minimal to no feedback required from preceptor)

OR

Not Applicable

Part II Goal 8: The student will be able to complete site specific projects and assignments. (20% of Total Evaluation)

Please indicate how many points of the possible 20 the student earned on his assignments. Then in the comment box below please list each assignment along with the points earned and the maximum points that were allowed in that assignment. [For example: Perhaps the student earned 7.6 points out of 10 on a case presentation, 4.6 out of 5 on a journal club and 3.9 out of 5 on a disease state presentation. The student's total score is 16.1 out of 20. You would enter all of this detailed information in the text box below and choose 16 (score rounded to the nearest whole or 1/2 point) from the drop box to the right.]