Student Name:

Grade for Mid Term   Final  

1	2	3	4	5
Needs extensive intervention; sometimes the preceptor must complete the task	Needs consistent intervention; preceptor must provide directed questioning in a problem-solving manner.	Requires only occasional intervention consisting of a single limited prompt	Requires no intervention	Requires no intervention; performs above expectations; the student teaches faculty something new

DIMENSIONS

1. COMMUNICATES WITH PATIENTS ABOUT PRESCRIPTION DRUGS
   
   • Interviews and councils patients on drug usage, dosage, packaging and storage
   • Discusses drug cautions, side effects, and patient conditions
   • Explains policies on fees and services
   • Relates to patients in a professional manner
   • Interacts to confirm patient understanding
   1   2   3   4   5  

2. MONITORS AND EVALUATES DRUG THERAPY: INITIAL AND ONGOING
   1. Establishes and interprets data bases
      • Data base includes active problems, PMH, pertinent PE, and lab data, hospital course
      • Medication history performed and complete
      • Medication profile complete and up to date
      • Pharmacokinetic parameters determined
      1   2   3   4   5  

   2. Identifies drug related problem(s)
      1   2   3   4   5  

   3. Recommends appropriate therapeutic plan(s)
      • Determines appropriate therapeutic endpoints
      • Recommends appropriate drug therapy (dose, duration, route, etc.)
      • Selects appropriate parameters to monitor efficacy and toxicity
      1   2   3   4   5  

   4. Carries out the follow-up plan(s)
      • Determines appropriate time(s) to re-evaluate patient and assess efficacy and toxicity
      • Conducts the follow_up plan in a timely manner
      1   2   3   4   5  

   5. Maintains professional-ethical standards
      • Exhibits reliability and credibility in dealing with others
      • Deals professionally and ethically with colleagues and patients
      • Maintains confidentiality
      1   2   3   4   5  

   6. Communicates with health professionals
      • Obtains or provides accurate and concise information in a professional manner
      • Uses appropriate oral, written and nonverbal language
      1   2   3   4   5  

   7. Retrieves and evaluates drug information
      • Selects best available resource for answering a drug related request in a timely fashion
      • Evaluates the quality of information obtained
      1   2   3   4   5  

   8. Demonstrates human relations skills
      • Displays an interest in others
      • Is sensitive to the needs, feelings, and concerns of others
      • Shows empathy
      • Listens, is nonjudgmental and responds appropriately to others' problems
      • Acts in the best interest of others
      1   2   3   4   5  

   9. Handles detail
      • Is conscientious in following appropriate work procedures
      • Is attentive to details and technical interrelationships in carrying out duties
      • Notice discrepancies and irregularities
      • Keeps accurate records and documents actions
      • Takes steps to ensure accuracy of work
      • provides an appropriate amount of detail
      • Keeps people informed
      • Follows up on actions
      1   2   3   4   5  

   10. Makes sound decisions
       • Uses good judgment in coming up with sensible, practical solutions to problems
       • Seeks out and utilizes important facts and information in decision making
       • Recognizes an evaluates available alternatives
       • Gives thought to possible consequences of decisions
       1   2   3   4   5  

   11. Organizes/Plans
       • Uses own and others' time effectively and efficiently
       • Is systematic and methodical in approaching activities
       • Sets meaningful goals
       • plans activities to meet objectives
       • Is well prepared
       • Is able to anticipate future needs
       1   2   3   4   5  

   12. Displays independence/Assertiveness
       • Self-directed in undertaking responsibilities
       • Articulates own viewpoint when dealing with others and in addressing controversial issues
       • Speaks out against questionable tactics and practices
       1   2   3   4   5  

   13. Learns in a self-directed manner
       • Conducts self-assessment
       • Acting on identified strengths and weaknesses, develops and learning plan
       • Pursues further knowledge independently
       • Aware of how professional organizations can facilitate life-long learning needs
       1   2   3   4   5  

Assigned Project or Presentation:

Evaluation:

Overall Instructor Comments:

Preceptor Name:

Student's Grade for Clerkship: (COMPLETE ONLY AT FINAL EVALUATION)

Date:

Many thanks on behalf of college of Pharmacy.