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DRAKEUNIVERSITY COLLEGEOFPHARMACY&HEALTHSCIENCES EXPERIENTIALPHARMACYEDUCATIONPROGRAM

StudentPerformanceAssessmentForm
(ThestudentandpreceptoreachcompleteonecopyofthisforminPEMSattheendofthe rotation)

StudentName RotationSite Preceptor'sSignature GradingGuidelines:

StartingDate

Student'sSignature

1. Bythelastdayoftherotation,thepreceptorreviewsthestudentsPEMSportfoliowhich includesdocumentationtoassessdevelopmentofskillsineachofthecompetencyareas (daily activity logs, abstracts, patient case presentations, intervention forms, special projectsandotherworkasassignedorselectedforsubmissionbythestudent). 2. The preceptor completes the final assessment form by entering a proficiency score for each activity listed under the four competency areas. The final page includes written comments on strengths and areas in need of improvement with a suggested plan for continuedstudentdevelopment. 3 The student will complete a selfassessment form and will meet with the preceptor to reviewtheirfinalassessmentsanddiscussanydiscrepancybetweenthetwo. 4. Bythelastdayoftherotation,theassessmentformsareinthestudentPEMSportfolioto be usedasatoolforstudentdevelopmentinremainingrotations. 5. Atthebeginningofthenextrotation,thestudentwillreviewcompetencyprogresswith thepreceptoranddiscusstherotationactivitiesthatthestudentwillfocusontofurther developproficiencyinthecompetencyareas. 6. Onthelastdayofeachrotation,thestudentmustsubmitthefinalpreceptorandtheself assessment forms in PEMS for review. If the student is not demonstrating adequate academic progress, the student will be contacted and a remediation plan will be coordinated with the subsequent experiential education faculty and the Director of ExperientialEducation,asappropriate. 7. For successful completion of the experiential education program, Doctor of Pharmacy candidatesmustattheendof40weeksofrotationsachieveandmaintainaproficiency scoreof4ineachoftheactivitieswithinthefourcompetencyareas. ProficiencyScore 5 Studentcompletesactivityatalevelbeyondexpectationsforanewgraduate. 4 Studentcompletesactivitywithminimalornopromptingandinterventionfromthe preceptor. 3 Studentcompletesactivitywithmoderatepromptingandinterventionfromthe preceptor.

2 Studentcompletesactivitywithextensivepromptingandinterventionfromthe preceptor. 1 Studentengagesinactivitybutisunabletocompletetheactivityevenwithprompting andinterventionorcompletestheactivityincorrectly N/A Althoughopportunitiesexisted,thestudentneverengagedinthisactivitytherefore not abletoassess ProfessionalCompetency1.0DrugTherapyProblemSolving Thestudentisabletodemonstrateproblemsolvinganddecisionmakingskillsnecessaryto evaluatedruguseandmonitorindividualpatients'drugtherapy. 1.1 ParticipateinDrugUseDecisionMaking 1.11 assistsprescribers,otherhealthcareprofessionalsand/orpatients toestablishtherapeuticobjectivesandobtainappropriatehealth services

1.12 compilesandevaluatespatientspecificinformation,includingdrug history,laboratoryandmedicalinformation 1.13 recommendsappropriatedrugentitiesforspecificpatientswith specificdiseases,usingappropriateprinciplesfrompathophysiology andtherapeutics. 1.14 recommendsappropriatedosageforms,formulations,androutesof administrationofspecificdrugentitiesforspecificpatients 1.15 recommendsappropriatedosesanddosingschedulesofdrugsfor patients,applyingtheprinciplesofpharmacokineticswhen necessary 1.16 understandsandappliestheprinciplesofformularymanagement 1.17 participatesinthedesign,implementation,oranalysisofdruguse evaluations 1.18 preparesanddeliversdrugtherapyrelatededucationalprograms 1.19 evaluatesclinicalstudiesandappliesepidemiologicand demographicdata 1.110 documentsdrugtherapyinterventionsincludingaplanforpatient followupusingamethodwhichcouldbesubmittedfor reimbursement 1.2 MonitorIndividualPatients 1.21 analyzesmedicationorders/prescriptionsfor patientissues,e.g., allergies,interactions, adverseeffects,dose/scheduleand dosageform 1.22 establisheswithprescribersand/orpatientsthetherapeutic endpointsofdrugtherapy,andmonitorforprogresstowardthese endpoints

1.23 monitors theextenttowhichpatientscomplywiththeirtherapeutic plans,andimplementsmethodstoassistpatientsinimproving compliance 1.24 monitorspatientsthroughthecourseoftheirdrugtherapyfor adversedrugreactions,andassistsprescribersinrevisingdrug therapyasneeded 1.25 monitorspatient'sdrugtherapyfordrugdrug,drugdiseaseand drugfoodinteraction,andassistsprescribersinrevisingdrug therapyasneeded ProfessionalCompetency2.0 Communication

Thestudentcancommunicate ideas,informationandanalysesinordertoeducate,atan appropriatelevel,colleagues,otherhealthprofessionals,studentsandpatients. 2.1 PatientCounseling 2.11 ensuresthatthepatient(orthepatient'sagent)understandsthe importance,benefits,risks,nature,andscopeofthetherapeutic careplanbeingimplemented 2.12 ensuresthatpatientsagreetoparticipateintheimplementationof thetherapeuticplans 2.13 ensuresthatpatientsunderstandthecorrectuseofmedications includedintherapeuticplans 2.14 usesappropriatecommunicationstrategiesalongwithcultural sensitivitywhencounselingpatientswhosecultureand/orlanguage isdifferentthanthestudent 2.2 ProfessionalCommunications 2.21 prioritizes druginformationrequestsandrespondsinatimely manner 2.22 askspertinentandrelevantquestionsforobtainingunknown informationforcolleagues,healthprofessionals,andpatients 2.23 usesappropriateformalwritingtechniqueswhenpreparingreports ordocuments 2.24 demonstratesappropriateprofessionalcommunicationwhen interactingwithpatients,pharmacists,staff,andotherhealthcare professionals 2.3 PrepareandProvideDrugRelatedInformation 2.31 useshealthrelatedandprofessionalliteraturetoacquirenew knowledge 2.32 organizesmaterialinsuchamannerastobeunderstoodbythe targetaudience

ProfessionalCompetency3.0 ProductandServiceManagement Thestudentisabletoutilizemanagementtheoryinplanning, organizing,directing,and controllingpharmaceuticalcaresystemsandpharmacybusinesspractice. 3.1 MaintainDrugProducts 3.11 understandsandusesmanagementsystemstoensurethatadequate suppliesofdrugproductsareavailabletomeetpatientcareneeds 3.12 selectsthedrugproductsourceofsupplybasedon biopharmaceutic,economic,andqualitycontrolinformation 3.13 ensuresthatdrugproductsarestoredunderappropriateconditions 3.14 ensuresthatdugproductsaredeliveredinatimely,safeand efficientmanner 3.15 ensuresthesecurityofdruginventory 3.2 ProvideDrugProductstoPatients 3.21 assuresthelegalityandcompletenessofthemedication order/prescription 3.22 transcribesamedicationorder/prescriptionfromaprescribervia telephoneorinperson 3.23 confirmsmedicationorder/prescriptionreceivedbyfax,nurse transcriptionorstandingorder 3.24 accuratelyfillsthemedicationorder/prescriptionfromstock, includingbulkcontainers,unitdose,etc.,usingappropriate packagingmethods 3.25 compoundsand/orpreparesdrugproductsusingappropriate ingredients,pharmaceuticalcharacteristics,calculationsand packaging/labelingrequirements 3.26 documentstheappropriatedispensingnotations,i.e.,product expiration,etc. 3.27 labelsthemedicationinacompleteandlegalmanner 3.28 filesmedicationorders/prescriptionsinasystematic,legalmethod

3.3

ComputerUtilization 3.31 retrievespatientinformationfromthecomputersystemto appropriatelyinterpretandanalyzemedication orders/prescriptions 3.32 usesinventorytrackingandorderingdatatoassessdrugavailability

3.33 accessesproductinformationtoassureconsistentpreparationand dispensingmethods 3.34 obtainsprescriberinformationasrequired 3.35 usesprotocolstoevaluateandprocessfrequent orders/prescriptions

3.4 ManageHumanandFinancialResources
3.41 assistsinplanning,implementationorevaluationofpharmacy servicesandprograms 3.5 PharmacyBusinessPractice 3.51 assistindesign,implementationorevaluationofaquality assuranceprogramforthepharmacy ProfessionalCompetency4.0 Professionalism

Thestudentpossessesadesireand motivationforlifelonglearningandapersonaland professionalvaluesystemconsistentwithpharmacyethicalandlegalstandards. 4.1 LifeLongLearning 4.11 usesappropriatemethodsfordiscoveringnewknowledge 4.12 demonstratesinitiativeinachievinglearninggoalsasidentifiedin therotationexperience 4.2 ValueandEthics 4.21 recognizesandincorporatesaholisticviewofpatientcare 4.22 acceptspersonalresponsibilityforpatientcare 4.23 makesdecisionsconsistentwithcurrentethicalandlegalstandardsofthe profession 4.24 workhabitsdemonstratepunctuality,theabilitytoprioritizeworkandmanage timeefficiently

Describestudentstrengths:

Describecompetencyareasthatneedimprovement:

Describeaplanofactionforcontinuedstudentcompetencydevelopment:

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