Interns evaluation of self, preceptor & site experience - Pharmacy ...
Interns evaluation of self, preceptor & site experience - Pharmacy ...
Interns evaluation of self, preceptor & site experience - Pharmacy ...
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COMMUNITY PHARMACY PRACTICE EXPERIENCE<br />
INTERN SELF-ASSESSMENT, PRECEPTOR & SITE EVALUATION FORM<br />
Orientation<br />
Intern and <strong>preceptor</strong> discussion <strong>of</strong> previous <strong>experience</strong><br />
Introduction to staff<br />
Tour <strong>of</strong> facility<br />
Expectations <strong>of</strong> <strong>preceptor</strong>s<br />
Policy and procedures <strong>of</strong> the <strong>site</strong><br />
Telephone and other accessories<br />
Preceptor contact information<br />
Plan for the completion <strong>of</strong> 480 hours.<br />
Communication skills:<br />
Able to think critically<br />
Exceed expectations Meets expectations Does not meet expectations<br />
Able to apply classroom knowledge to current <strong>experience</strong><br />
Exceed expectations Meets expectations Does not meet expectations<br />
Able to organize information<br />
Exceed expectations Meets expectations Does not meet expectations<br />
Able to read and listen effectively<br />
Exceed expectations Meets expectations Does not meet expectations<br />
Able to speak and write effectively<br />
Exceed expectations Meets expectations Does not meet expectations<br />
Able to communicate with diverse population (Patients, Health Care Pr<strong>of</strong>essionals, etc)<br />
Patients<br />
Exceed expectations Meets expectations Does not meet expectations<br />
Healthcare pr<strong>of</strong>essionals<br />
Exceed expectations Meets expectations Does not meet expectations<br />
Education and Training Department, <strong>Pharmacy</strong> Council Page 1
Preceptors<br />
Exceed expectations Meets expectations Does not meet expectations<br />
Patient and Healthcare pr<strong>of</strong>essionals from a variety <strong>of</strong> background<br />
Exceed expectations Meets expectations Does not meet expectations<br />
Work colleagues<br />
Exceed expectations Meets expectations Does not meet expectations<br />
Minimal non-verbal distractions<br />
Good eye contact<br />
Exceed expectations Meets expectations Does not meet expectations<br />
Limited “ums”, “you know”, and “like”<br />
Exceed expectations Meets expectations Does not meet expectations<br />
Counsels patients on medication uses<br />
Prescription product<br />
Exceed expectations Meets expectations Does not meet expectations<br />
Over-the-counter product<br />
Exceed expectations Meets expectations Does not meet expectations<br />
Dietary supplements<br />
Exceed expectations Meets expectations Does not meet expectations<br />
Medical devices (i.e. blood glucose machine)<br />
Exceed expectations Meets expectations Does not meet expectations<br />
Pr<strong>of</strong>essional Skills and Understanding<br />
Able to read and interpret prescriptions<br />
Exceed expectations Meets expectations Does not meet expectations<br />
Able to understand and participate in prescription processing and filling<br />
Exceed expectations Meets expectations Does not meet expectations<br />
Able to identify potential drug-related problems and causes<br />
Exceed expectations Meets expectations Does not meet expectations<br />
Education and Training Department, <strong>Pharmacy</strong> Council Page 2
Able to identify and remedy medication errors<br />
Exceed expectations Meets expectations Does not meet expectations<br />
Able to document medication therapy management interventions<br />
Exceed expectations Meets expectations Does not meet expectations<br />
Able to reach and provide (written and/or verbal) medical information to:<br />
Health Care Pr<strong>of</strong>essional(s)<br />
General public<br />
Exceed expectations Meets expectations Does not meet expectations<br />
Specific areas in which I can improve my communication:<br />
_____________________________________________________________________________________<br />
_____________________________________________________________________________________<br />
_____________________________________________________________________________________<br />
Education and Training Department, <strong>Pharmacy</strong> Council Page 3
COMMUNITY PHARMACY PRACTICE EXPERIENCE<br />
Preceptor & Site Evaluation Form<br />
Name <strong>of</strong> Preceptor: ____________________________________________________________________<br />
Name <strong>of</strong> Intern: _______________________________________________________________________<br />
Please read each <strong>of</strong> the statements carefully, and then indicate your level <strong>of</strong> agreement and disagreement:<br />
Preceptor Evaluation<br />
Strongly<br />
agree<br />
Agree Neutral Disagree Strongly<br />
Disagree<br />
Not<br />
Applicable<br />
Communicated clearly goals and 5 4 3 2 1 N/A<br />
objectives <strong>of</strong> the internship<br />
Reviewed the <strong>Pharmacy</strong> Council’s 5 4 3 2 1 N/A<br />
expectations with me (e.g. objectives,<br />
daily journal, <strong>self</strong> <strong>evaluation</strong>)<br />
Introduced me to the other personnel, 5 4 3 2 1 N/A<br />
provided contact information, etc.<br />
Assessed my abilities, needs, and 5 4 3 2 1 N/A<br />
career goals<br />
Gave me specific assignments 5 4 3 2 1 N/A<br />
Emphasized to me performance<br />
5 4 3 2 1 N/A<br />
standards<br />
Resources were adequate to complete 5 4 3 2 1 N/A<br />
internship objectives<br />
My <strong>preceptor</strong> or mentor was<br />
5 4 3 2 1 N/A<br />
sufficiently accessible to facilitate<br />
attainment<br />
My <strong>preceptor</strong> or mentor spent<br />
5 4 3 2 1 N/A<br />
sufficient time with me to guide me<br />
Stimulated problem solving through 5 4 3 2 1 N/A<br />
interaction<br />
Had an organized approach to<br />
5 4 3 2 1 N/A<br />
precepting<br />
Treated me with respect 5 4 3 2 1 N/A<br />
Promoted an environment conducive 5 4 3 2 1 N/A<br />
for learning<br />
Taught me things I did not already 5 4 3 2 1 N/A<br />
know<br />
Provided me with feedback on my 5 4 3 2 1 N/A<br />
performance<br />
Site <strong>evaluation</strong><br />
N/A<br />
Site was conducive to learn 5 4 3 2 1 N/A<br />
The <strong>site</strong> provided sufficient<br />
5 4 3 2 1 N/A<br />
opportunity for me to meet the general<br />
objectives<br />
Other personnel were respectful to the<br />
intern<br />
5 4 3 2 1 N/A<br />
Education and Training Department, <strong>Pharmacy</strong> Council Page 4
Preceptor/Site <strong>evaluation</strong> continued<br />
In the space provided, please identify the primary strengths and suggestions for enhancement <strong>of</strong> the<br />
community internship <strong>site</strong> and instructor<br />
Preceptor Strengths:<br />
Preceptor suggestions for enhancement:<br />
Site strengths:<br />
Site suggestions for enhancement:<br />
What i like most about the <strong>experience</strong>:<br />
What I would change about the <strong>experience</strong>:<br />
Intern’s signature: ____________________________________ Date: _________________________<br />
Education and Training Department, <strong>Pharmacy</strong> Council Page 5
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