Advanced Pharmacy Practice Experience Evaluation

Administrative Pharmacy Student Evaluation Form

Student:

Preceptor:

Rotation Dates:

Directions: Use the following descriptions under Level of Performance as a guideline to determine the Grade to be assigned for a specific Category of Student Performance. If a student was not expected to perform in a certain Category, please place “NA” in the box pertaining to that grade. Preceptors must use only the designated percentage grades listed below for each category (0, 25, 55, 65, 75, 85, 95, or 100%).

Preceptors should refer to the rotation goals/objectives and expectations to determine how the student performs for each of the categories listed below. Students should be evaluated based on their achievement and mastery of the stated rotation Goals and Objectives as outlined in the online rotation manual.

Part I. (70 percent of final grade)

Category of Student Performance	Grade	Levels of Performance (other categories include “NA” – Does Not Apply or Unable to Assess)
Category of Student Performance	Grade	Performs at an Unacceptable Level 0, 25, or 55%		Below Average / Performs Below Minimal Expectations 65%	Average / Meets the Minimal Expectations 75%	Above Average / Performs Above Expectations 85%	Outstanding / Exceeds Expectations 95 or 100%
I. Basic Information
Data Collection		Consistently fails to obtain proper information from proper sources		Collects some data, but omits several basic details	Collects obvious data, but usually does not collect proper details	Usually collects obvious and detailed data from proper sources	Effectively obtains complete data for each problem using a variety of sources
Drug Information/ Literature retrieval				Collects some data, but omits several basic details
Comments:
II. Decision Making and Problem Solving Skills
Problem Identification		Unable to identify basic problems; unable to provide solutions once problems have been identified	Usually unable to identify basic problems; unable to prioritize problems or provide solutions		Able to identify basic problems; usually able to prioritize problems and provide solutions	Usually able to identify the majority of problems; able to prioritize problems and usually able to provide solutions	Able to identify all active & inactive problems, correctly prioritize problems & able to provide solutions to problems

Category of Student Performance	Grade	Levels of Performance (other categories include “NA” – Does Not Apply or Unable to Assess)
		Performs at an Unacceptable Level 0, 25, or 55%		Below Average / Performs Below Minimal Expectations 65%	Average / Meets the Minimal Expectations 75%	Above Average / Performs Above Expectations 85%	Outstanding / Exceeds Expectations 95 or 100%
Problem Solving		Unable to solve basis problems		Correctly solves basic problems, but does not demonstrate critical thinking skills	Correctly identifies and solves problems, but may not evaluate critically	Usually demonstrates critical thinking skills when solving problems		Demonstrates characteristics of a critical thinker when solving problems
Integrate, Apply and Retain New Information Acquired During the Rotation		Does not demonstrate the use or integration of new knowledge		Occasionally able to use basic elements of new knowledge	Able to use basic & some advanced elements of new knowledge	Able to use & integrate basic & some advanced elements of new knowledge		Able to explain, use, & integrate basic/advanced elements of new knowledge
Comments:
III. Professional and Communication Skills
Professional interactions		Does not talk to or acts independently of other team members	Occasionally observes but without active participation in team activities		Interacts with other team members when asked	Succinct/tactful interactions; shares information with team members		Essential team member; actively participates & contributes in all activities
Verbal Presentation		Usually unprepared for presentations	Usually prepared but presents poorly cited or incorrect information		Presents correct & well-cited information; usually articulate	Presents well-cited topics, with correct information; well-articulated		Articulately presents correct, well-cited information with sophistication
Written Communication		Assignments late, illegible, & with grammatical, spelling, and organizational errors	Assignments done on time; but inarticulate, poorly-cited, or with some grammatical or spelling errors		Well-cited information; rare grammatical or spelling errors	Well-cited information with articulation; no writing errors		Critically presented, well-cited information with articulation, clarity, & insight.
Verbal Communication with Patients &/or others		Use of unclear language, incorrect terminology, or offensive tone	Impersonal & abrupt manner, but generally provides correct information		Maintains a good dialogue; occasional use of unclear or inappropriate terminology	Directs conversation, allows patient or client to easily provide & receive info		Uses clear & correct language; effective communication with each patient or client

Category of Student Performance	Grade	Levels of Performance (other categories include “NA” – Does Not Apply or Unable to Assess)
Category of Student Performance	Grade	Performs at an Unacceptable Level 0, 25, or 55%		Below Average / Performs Below Minimal Expectations 65%	Average / Meets the Minimal Expectations 75%	Above Average / Performs Above Expectations 85%	Outstanding / Exceeds Expectations 95 or 100%
Reliability		Failed to meet many deadlines or one unexcused absence or consistently tardy to patient care activities	Missed an important deadline or several activities not completed in a timely manner; occasionally tardy to patient care activities		Regularly attends all patient care activities and work consistently completed on time	Regularly attends all patient care activities and demonstrates significant advanced planning and/or completes some projects ahead of time	Consistently plans ahead, completes all assignments and projects in advance; motivates other students to work ahead
Motivation		Speaks & acts on request only, often refused to participate	No self-motivation, but completes work if directed by the preceptor		Sometimes motivated if need is obvious	Makes decisions independently, but acts only after consultation with preceptor	Consistently initiates activities; uses spare time wisely
Organization		Disorganized work habits, necessary information often missing	Occasionally unorganized and unprepared		Usually well-organized, occasionally unable to retrieve information	Well-organized, information easily retrievable	Completely organized, information readily retrievable
Comments:
TOTAL

Part 2. Site Specific Performance Objectives (30 percent)- You can enter up to 1 decimal place.

Points Earned Total Possible Points

1. Formal write up ________ points out of _______points

2. Written Exams ________ points out of _______points

3. Case presentations ________ points out of _______points

4. Project(s) ________ points out of _______points

5. Site Specific Objective # 1

___________________________________ ________ points out of _______points

6. Site Specific Objective # 2

___________________________________ ________ points out of _______points

TOTAL (Max 30 points) __________ points

Final Grade: Total Points from Part 1/ # of categories in Part 1 _____________ x (0.7) = ______ +

Total Points from Part 2 (max 30 points) ______________________

= _______________

Grade:

A- 89.5 - 100 %

B- 79.5 – 89.4 %

C- 69.5 - 79.4 %

F- < 69.5 %

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