Competency Attitudes and Behaviors

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					                            ATTITUDES and BEHAVIORS

PHRD 4300 Experiential Practice III                                  Below expectations

I meet expectations in this area because I demonstrate professionalism, positive attitude
and professional behavior in all I do in pharmacy practice.

I am a firm believer that what and how I do things, how I act and my appearance not only
reflect back on me but also on my learning institution, my employer and me. It is
because of this belief that I always conduct myself and my performance to the best of my
ability with a positive attitude. I want people to have a good experience with me and to
feel confident in the information I convey to them. I never take my counseling
responsibilities lightly. If I do not have an answer for a patient I tell them I am not sure
but I will find out. This promotes a positive reflection back on UCHSC SOP and me.

I take pride in my work and want others to do the same. When previously training
employees, I always emphasized that how they did their job and their attitude towards
that job reflected back on them more than the employer and they should always do their
best. I am always on time and strive to abide by all guidelines set forth by UCHSC SOP
and the pharmacy I am conducting my modules at. I want to do things the right way and
I will seek guidance if I have any doubts about what I am doing.

Also, during the school year I participate in various community service activities. I try to
attend as many seminars and brown bags that I feel are pertinent to pharmacy practice or
that are of special interest to me.

Comment: the student is to be congratulated for his/her attitudes and behaviors but
the statement is “below expectations” because the description provides superficial
information on multiple topics whereas in-depth discussion of a single issue is
preferred. In addition, there is no reflective writing to indicative that the student
has put time and effort in to thinking how he/she could improve.

The student should be encouraged to revise the statement. For example, the second
paragraph could be followed by a specific example based on a patient interaction.
The student might describe how he/she introduced him/herself to a patient by
profession (pharmacy student) and by name (Chris Turner) before offering to help
with the patient’s problem. The statement might go on to describe how he/she drew
the patient’s attention to his/her name badge and pharmacy intern license number
and that, by doing so, went some way to gaining the patient’s trust by showing that
he/she was willing to put his/her name behind his/her advice. With respect to
reflection and further improvement, it would be reasonable if the student indicated
his/her future intention to always wear his/her UCHSC photographic identification
badge in addition to a name badge and intern license number.
PHRD 4300 Experiential Practice III                                  Meets expectations

I met expectations for the professional attitudes and behaviors competency through an
interaction I had with a hypertensive woman in the OTC aisle. I had not taken my blood
pressure cuff into the OTC aisle with me on my first two visits because I did not feel
comfortable doing that. I felt that patrons in King Soopers would not be interested in a
pharmacy intern in the OTC aisle measuring their blood pressure and I felt that standing
there with my blood pressure cuff and asking patients if they would like me to take their
blood pressure would be too invasive.
         After I received my last set of competency statements back I read the suggestion
to take my blood pressure cuff into the OTC aisle and wondered if I was trying to justify
not taking my BP cuff into the OTC aisle simply because doing so would take me out of
my comfort zone. I decided to take my BP cuff with me on my third visit to the OTC
aisle. I have to admit that I was still feeling quite uncomfortable with the whole idea and
decided to leave the equipment in my bag and go out to the OTC aisle without it. As I left
the pharmacy I passed a woman who was standing in line to get her prescription. She was
browsing the cold medicines on the shelf next to her and I asked if she needed any help
finding anything or if she had any questions for me. She said she didn’t really have any
questions; she was buying a decongestant for her son who is 29 years old and waiting to
get her prescription.
         As I turned to walk away she began speaking again. She said that she had been
diagnosed with hypertension a few months before and had been taking her medication
every day as she was told to do. She was concerned that she couldn’t tell if the
medication was doing any good and that she didn’t feel any different. I began by asking
her questions about her diagnosis. I asked if she remembered what her blood pressure had
been, when she had been diagnosed and what medication(s) she was taking. She did not
remember what her blood pressure had been and was not even sure what a high value for
blood pressure would be. She said she had been taking the medication she was picking up
for about 4 months now and had not seen her doctor since a one month check up after she
was originally put on the medication. It turned out that she was on HCTZ 25mg every
day. I began to counsel her on how the drug works, how it lowers blood pressure and why
it is a good initial drug to try to lower blood pressure.
         I then started to explain what constituted high blood pressure. As I was explaining
I noticed that the woman had begun to look a little upset. She said she was sure that her
doctor had said it was much more than 140/90 because she thought she remembered it
being somewhere around 170. She was very vague with her explanation but I could tell
she was concerned because she felt strongly that her blood pressure had been much
higher than what I had explained as her goal. It was at this moment that I felt confident
that this woman could benefit from having her blood pressure measured for several
reasons. First, I wanted to be sure she left that day with a good understanding of her
current blood pressure, her goal blood pressure and appropriate ways of monitoring it
between visits with her doctor. Second, I could not be sure that her blood pressure was
really as high as she suspected without measuring it. If it was around 170, I felt she
needed to be counseled on returning to her doctor for additional drug considerations. I
know that patients with systolic blood pressure values higher than 160 should be started
on at least two medications for maximal blood pressure lowering. If this was the case
with her, HCTZ alone was not enough.
         I told the patient that I had a blood pressure cuff in my bag and would be more
than happy to take her blood pressure. She seemed very uneasy with this idea. This
discouraged me because I was finally feeling the importance of having my blood pressure
cuff with me. She began to look around at the other people in the pharmacy and I realized
that she did not feel comfortable having her blood pressure taken in the middle of the
pharmacy waiting area. I pointed to the corner with the automatic blood pressure
measuring machine and asked her if the more private spot would be better. She agreed
and I took her blood pressure. Her values were 166/78 and 164/84. From this I was able
to accurately counsel her without the questions I had before.
         We were sitting at the automatic blood pressure machine so first I explained how
she could monitor her blood pressure on her own to see how her medication was affecting
her blood pressure. We also discussed what the overall goal of hypertension treatment
was and how lowering her blood pressure would decrease her risk for heart problems,
stroke, etc. I also explained that I felt she should go back to her doctor so he could
determine if HCTZ alone was appropriate therapy for her. I tried to explain that she
would probably need to be placed on an additional medication to get her blood pressure
down to goal and that actively taking part in her therapy through blood pressure
monitoring and recording would be very beneficial for her doctor.
         I feel that I met expectations for the professional attitudes and behaviors
competency through this interaction because it made me understand that providing blood
pressure counseling will often involve measuring a patient’s blood pressure. It made me
realize that feeling uncomfortable about taking my blood pressure cuff into the OTC aisle
was not a valid reason to not provide that service. Measuring her blood pressure enabled
me to counsel her on so many aspects of her therapy, including questioning the adequacy
of HCTZ as her only blood pressure medication. She has stage II hypertension and an
initial 2-drug therapy is almost always needed for these patients. I feel that all of this fits
the professional attitudes and behaviors competency because my perspective changed so
drastically when I opened myself up to trying something that had initially made me feel
         In the future I will take my blood pressure cuff with me when I am counseling
patients. I realize that I do not have to wear my stethoscope around my neck and bother
every patient about their blood pressure, but having my cuff available when I need it is a
critical part of blood pressure counseling. This patient was thankful to have me there to
explain her blood pressure therapy and she was not at all put off that I offered to take her
blood pressure. I realize now that there is a good medium between how I anticipated
blood pressure measurements in the OTC aisle would be and how to offer the service
appropriately. Until I was presented with the situation, I was unable to see how beneficial
this could be to my profession. In the future, I hope to lose these inhibitions that hinder
confidence in my abilities.

Comment. The statement meets expectations for PHRD 4300. Students are expected
to go outside their comfort zones in all experiential courses and the statement
provides a good example for PHRD 4300. The student should be complimented on
his/her insight that individuals uncomfortable facing a challenge can always find
reasons not to take up the challenge. The “how to further improve” reflection is
insightful. If a student goes outside his/her comfort zone and has a good experience,
he/she is more likely to have the self-confidence to take whatever future
opportunities arise to again go outside his/her comfort zone.

PHRD 4300 Experiential Practice III                                  Exceeds expectations

A statement that meets or exceeds expectations for PHRD 4350 or 5300 (Experiential
Practice IV or V)

PHRD 4350 Experiential Practice IV                                   Below expectations

A statement below or meets expectations for PHRD 4300 (Experiential Practice III)

PHRD 4350 Experiential Practice IV                                   Meets expectations

I met expectations for the professional attitudes and behavior competency during a visit
to my community pharmacy. I was standing in the OTC aisle looking at various products
since there were no patients around. Then, I noticed that somebody was heading towards
me. I turned around to greet this person. I also asked him if he had any questions about
any of the products, but instead, he started off by telling me that he is part of the store’s
security. (At the time, I thought he really needed my help). Then, with a confused look
on his face, he asked me what I was doing. I replied by introducing myself to him and
stating that I am a P2 pharmacy student at UCHSC and that I was assigned to this store to
answer patients’ questions regarding OTC products and other medical conditions they
may have. Even though I stated this to him, he still seemed like he didn’t believe me
although I was clearly wearing my name tag and student ID. I added by telling him that
the pharmacist knew that I was here doing this assignment. I took this opportunity to
inform him that I will continue to be here more frequently in the next few months. So
after confirming the validity of my presence, and also in a sarcastic way, he replied by
saying, “fun job.” He started to walk away and I walked towards his direction so that I
could at least say something that would let him know that this “job” is important. I ended
up saying, “We want to be accessible to our patients so that we can help them as much as
         This statement demonstrates that I met expectations for the competency of
professional attitudes and behaviors because it reminded me that I need to act in a
professional manner at all times, especially when people doubt you. Instead of just
letting this person walk away, I was able to defend the importance of this assignment by
at least replying to him the way I did.
         I’m glad that I was able to experience this situation. Even though this was a brief
encounter, I think that I at least made him aware that pharmacists do more than just stay
on the other side of the pharmacy counter (which is why he probably thought I wasn’t
where I was “supposed” to be). Doing this assignment actually helps increase patient’s
awareness of the pharmacist’s role. This is because I’ve noticed that some patients
decline my help when I first offer it to them, but then when I offer help to another patient
and the previous patient sees me helping them, they then tend to want my help too.
         Last semester, I had an experience similar to this because I had a patient who
doubted my ability to administer a flu shot to her. Although I handled that situation
professionally, at that time, I was offended. I’ve improved since last semester because
from this experience with the store security, I didn’t get offended. This person was just
doing his job as I was doing mine too. I’ve learned to realize that everybody has their
own pre-conceived notions and as pharmacists we need to be confident and do our best to
let patients know that we do more than just stand behind the pharmacy counter.
         Something I would have done differently is to ask this person again if he had any
questions about any OTC products to let him know that I was serious about the
assignment and to let him know that my help is offered not only to patients, but to him as
well. I would have also asked him if I needed to talk to anyone else (like a manger or
head of security) to tell them that I will continue to be at the store in the next few months
so that we could prevent further suspicions.

Comment: the statement meets expectations for PHRD 4350. The student has given
a clear account of the encounter and a convincing rationale to justify his/her
improved level of competency. It shows increasing self-confidence and his/her
intention to treat everyone in the pharmacy as a potential patient who would benefit
from his/her counseling on health-promotion, disease-prevention and non-
prescription medication issues. He/she should be congratulated for that approach.

PHRD 4350 Experiential Practice IV                                    Exceeds expectations

A statement that meets or exceeds expectations for PHRD 5300 (Experiential Practice V)

PHRD 5300 Experiential Practice V                                     Below expectations

A statement below or meets expectations for PHRD 4350 (Experiential Practice IV)

PHRD 5300 Experiential Practice V                                     Meets expectations

I met expectations for professional attitudes and behavior competency while interacting
with a drunk man. A man, obviously inebriated based on the stench of his breath and his
actions, came up and interrupted me while I was counseling a different patient. He
started offering his own advice to the patient whom I was already counseling. I told the
man, “Sir, if you need any assistance with any over the counter medications I'd be happy
to help as soon as I am finished with this lady.” Surprisingly he backed off after that. It's
a good thing that he wasn't an angry drunk. After finishing with the patient I was with, I
helped the rude, drunk man. I could have easily walked away and not thought twice
about him, but I remained professional and helped the man just as I would help anyone
else. He explained that he needed some wound care items for a homeless women he had
just met. Apparently she had some sort of cut so I fixed him up with some bandages,
generic Neosporin®, and he said that she insisted on some hydrogen peroxide, so he
bought some of that too.
        This interaction demonstrates that I met expectations for professional attitudes
and behavior competency because I helped a man who was drunk and overtly rude to me
while I was with another patient. But instead of blowing him off and compromising his
care, I helped him as I would help anyone else. And it's a good thing that I assisted him
because I was actually really helping someone else. This demonstrates improved
competency because last year I would have ignored this man or asked my preceptor to
take care of him.
         In the future I can definitely improve. While I did help the man, I didn't ask as
many questions as I should have about his new friend's injury. I should have found out
where the injury was, when it happened, how severe it was and if she was currently
treating it. Even though it may have been difficult to elicit that kind of information from
this type of patient, it would have been worth it because the injured patient could
potentially have received better all around care. And I believe that you can encounter
patients like this in a community pharmacy setting more often than you'd like to imagine.
Knowing that, it's good to learn how to effectively communicate with them in a
professional manner now to avoid problems in the future.

Comment: the statement meets expectations for PHRD 5300. Students in 4300 and
4350 are expected to care for patients who present routine problems and challenges
but it’s reasonable to expect students in 5300 to care for more difficult and
challenging patients. Students in 5300 should be encouraged to involve themselves
whenever an unusual or challenging situation arises to enhance their learning, build
self-confidence and broaden their experience base. For further improvement, the
student should be challenged on his/her knowledge of local resources. Does he/she
have contact information for the closest community health center which provides
care for the homeless? Also, what immunizations would he/she recommend for
homeless persons?

PHRD 5300 Experiential Practice V                                    Exceeds expectations

I met expectations for social interaction by informing and educating a friend about the
benefits of getting the flu shot. I was approached by a friend who had questions about the
influenza vaccine. She works in an orthodontist’s office and was concerned about the
large numbers of children that she is around all day. She stated that several of their
patients had been coming in with colds and flu-like symptoms. She and her husband are
currently trying to conceive, and she was worried about the consequences of getting the
flu during her potential pregnancy. I told her that she would be a good candidate for the
influenza vaccine since she works in health care and is around a younger population for
most of her day. I explained that if she were to become pregnant and then come down
with the flu, she would be at an increased risk of complications from the illness. I asked
her if she was allergic to eggs, and she said that she was not. She then explained to me
that she would be more interested in getting the inhaled version of the vaccine. I then
informed her that the injection is not a live vaccine, but the inhaled formulation is. I told
her that since she was not positive that she was not pregnant at the time, she should get
the injection instead of the inhaled live vaccine. She had heard that the vaccine may
actually give her the flu and did not want this to happen. I let her know that since the
vaccine was not live, she would not get the flu from the vaccine. I told her that she might
get a local reaction such as arm stiffness or soreness at the injection site. She was still
not convinced that she needed to get the vaccine. She stated that she had never had the
flu before, so she thought that she might just take her chances. I felt that it was important
for her to receive the vaccine, so I told her that I would go with her and get vaccinated at
the same time. I had been thinking about getting vaccinated, but I do not like needles or
shots. I had decided that I would get one only if there was a clear reason for me to get
one. This was the reason that I had been waiting for. After all, how can I recommend
that patients get the vaccine when I will not? She said that she would get the vaccine if I
would go with her and get one too. I then pushed my dislike for needles aside and we
went to a flu-shot clinic. We both got our vaccinations and, so far, we are both healthy
and happy.

This is an improvement over last semester because I realized that part of being a
professional is recognizing our own weaknesses and learning from them. I realized that it
was unfair for me to recommend a vaccine to a patient that I myself did not plan on
getting. I took this weakness and used it to grow. I received the vaccine and put myself
into the patient’s shoes. I feel that this is a very important part of being a professional.
Last semester, I might have just told her that it was her decision, and she could do what
she felt was appropriate. This semester, I took the initiative to show her how important it
was by getting the vaccine myself. I could have improved this encounter by calling her a
few days later to ask how she was feeling and if she had had any kind of local reaction to
the vaccine. This semester has been one of growth and improvement. I have gained a
great deal of knowledge from both my encounters as well as my patients. It has been a
very helpful process in molding me into a better pharmacist.

Comments: this statement exceeds expectations for PHRD 5300 even though the
student claimed “meets expectations”. As the student points out, it is unreasonable
to encourage patients to practice disease-prevention if you are not willing to follow
the same practice. It demonstrates “exceeds expectations” because the student
accompanied the patient to the flu-shot clinic (i.e., it would be unreasonable to
expect every student in PHRD 5300 to accompany a nervous/reluctant friend to a flu
shot clinic. However, for the reasons stated, it is reasonable to expect every student
to be immunized against the flu and the statement would be “meets expectations” if
the student had been vaccinated without accompanying the patient.

The student’s reflection on how to further improve is superficial. Students in PHRD
5300 should have developed the skill of systematically reviewing the encounter from
start to finish and presenting multiple options for further improvement (i.e.
convince the reader that substantial time and effort has gone into the reflection. The
patient is trying to conceive and, as a way to further improve, it would have been a
simple exercise to extend the interaction to deal with health promotion in the
context of a pregnancy (folic acid supplement, smoking and alcohol use, etc.).
Competency in attitudes and behaviors involves taking proactive steps when
necessary to bring topics to a patient’s attention rather than acting passively and
only dealing with a specific question asked by the patient.

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