Interns evaluation of self, preceptor & site experience - Pharmacy ...

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COMMUNITY PHARMACY PRACTICE EXPERIENCE Preceptor & Site Evaluation Form Name of Preceptor: ____________________________________________________________________ Name of Intern: _______________________________________________________________________ Please read each of the statements carefully, and then indicate your level of agreement and disagreement: Preceptor Evaluation Strongly agree Agree Neutral Disagree Strongly Disagree Not Applicable Communicated clearly goals and 5 4 3 2 1 N/A objectives of the internship Reviewed the Pharmacy Council’s 5 4 3 2 1 N/A expectations with me (e.g. objectives, daily journal, self evaluation) Introduced me to the other personnel, 5 4 3 2 1 N/A provided contact information, etc. Assessed my abilities, needs, and 5 4 3 2 1 N/A career goals Gave me specific assignments 5 4 3 2 1 N/A Emphasized to me performance 5 4 3 2 1 N/A standards Resources were adequate to complete 5 4 3 2 1 N/A internship objectives My preceptor or mentor was 5 4 3 2 1 N/A sufficiently accessible to facilitate attainment My preceptor or mentor spent 5 4 3 2 1 N/A sufficient time with me to guide me Stimulated problem solving through 5 4 3 2 1 N/A interaction Had an organized approach to 5 4 3 2 1 N/A precepting Treated me with respect 5 4 3 2 1 N/A Promoted an environment conducive 5 4 3 2 1 N/A for learning Taught me things I did not already 5 4 3 2 1 N/A know Provided me with feedback on my 5 4 3 2 1 N/A performance Site evaluation N/A Site was conducive to learn 5 4 3 2 1 N/A The site provided sufficient 5 4 3 2 1 N/A opportunity for me to meet the general objectives Other personnel were respectful to the intern 5 4 3 2 1 N/A Education and Training Department, Pharmacy Council Page 4
Preceptor/Site evaluation continued In the space provided, please identify the primary strengths and suggestions for enhancement of the community internship site and instructor Preceptor Strengths: Preceptor suggestions for enhancement: Site strengths: Site suggestions for enhancement: What i like most about the experience: What I would change about the experience: Intern’s signature: ____________________________________ Date: _________________________ Education and Training Department, Pharmacy Council Page 5
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Page 3: Able to identify and remedy medicat

Interns evaluation of self, preceptor & site experience - Pharmacy ...

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