SUMMATIVE EVALUATION

                                                                       AMBULATORY CARE ROTATION

Resident:                                                                                              Date Completed:

Preceptor:                                                                                             Time Period of Learning Experience:

    This form documents resident attainment of goal areas formally taught in the learning experience. Evaluation of goal mastery is based on preceptor judgment of resident performance on the associated objectives listed
      below each goal.
    There are two categories of evaluation. The first category is an evaluation of goals designated for formal evaluation. The second category is of goals selected to be formally taught in the learning experience, but not
      chosen for formal evaluation.
 Preceptor will provide a narrative commentary for each goal in the first category of evaluation which is based on current resident performance level and reflects the aggregate resident activity during the rotation.
NI = Needs Improvement; SP = Satisfactory Progress; ACH = Achieved

    Category 1: Goals Designated for Formal                                  DESCRIPTION OF REQUIREMENTS                      NARRATIVE COMMENTARY                      NI            SP           ACH

Goal S1:       Take personal responsibility for attaining                  The resident is expected to prepare for
               excellence in one’s own ability to provide                  clinic beforehand by printing and
               pharmaceutical care.                                        reviewing patients, preparing questions
OBJ S1.2       (Characterization) Display initiative in                    for interviews and for health care
                                                                           practitioners. Daily activity is directed
preventing, identifying, and resolving pharmacy-related                    toward improved patient outcomes and
patient-care problems.                                                     documentation of progress is expected.
OBJ S1.3       (Organization) Choose daily activities so                   A written log of clinic activities is kept
that they reflect a priority on the delivery of direct                     and reviewed at least every other day
patient care.                                                              with the preceptor. Findings regarding
 OBJ S1.4 (Synthesis) Devise efficient                                     medication problems, omissions, and
strategies for one’s own practice activities that maximize                 needs are communicated to the health
the delivery of appropriate direct patient care to each                    care team and the patient is educated
patient within a limited time frame.                                       appropriately. The resident shows
                                                                           progress in designing and managing their
                                                                           day for efficiency, and these activities are

Goal S3:       Demonstrate the characteristics of a                        The resident meets dress code, is
               professional.                                               prepared with patient information, arrives
OBJ S3.1       (Organization) Choose daily activities so                   on time, and participates as a respected
                                                                           professional vs. observer. The resident
that they reflect the pursuit of expertise in the                          addresses the team with respect and tact
development of direct patient-care problem-solving                         as s/he presents information directed
skills.                                                                    toward patient improvements. Actions in
OBJ S3.4       (Characterization) Consistently maintain                    the clinics are presented without undue
personal self-control and professional decorum.                            emotion and differences and conflicts are
OBJ S3.5       (Characterization) Demonstrate acceptance                   handled professionally, without patient
of one's professional responsibility toward colleagues                     involvement. The resident directs energy
                                                                           and goals to the good of the patient and
and the health system through commitment to one's          the institution.
team..                                                     The resident is as assertive as necessary
OBJ S3.7      (Organization) Present pharmacy concerns,    without alienating another member or
solutions, and interests in an assertive manner.           pharmacy as a service.
Goal S9:      Solve practice problems efficiently.         The resident demonstrates problem
OBJ S9.1      (Application) Demonstrate consistent use     solving by reviewing possible causes,
of a systematic approach to problem solving.               researching, weighing options and
OBJ S9.2      (Application) Use consensus-building         choosing based on patient factors and
                                                           goals set. The resident further weighs the
skills.                                                    options of addressing the team, selecting
                                                           strategy suitable for the players, and
                                                           designed for the patient’s good.
Goal S19:         Manage time effectively to fulfill       Residents will need to work with
practice responsibilities.                                 efficiency in the clinic, prepare on their
                                                           own, at times, and pace themselves to
                                                           prepare on time throughout the rotation.
                                                           Missing clinic time is not an option
                                                           unless agreed to by the preceptor. Follow
                                                           up with team members on outstanding
                                                           questions or issues are imperative.
Goal P1:          Establish a collaborative working        Work to understand the motivations,
relationship with physicians and other health care         requirements, needs and challenges of the
providers in the health system.                            medical team members to better support
                                                           them and their patient related activities.
                                                           Attempt to anticipate their needs and
                                                           surpass them.
Goal P2:      Design, recommend, monitor, and              This objective is paramount to the
              evaluate patient-specific therapeutic        residency rotation experience.
              regimens that incorporate the principles
                                                           The resident is expected to prepare and
              of evidence-based medicine (the
                                                           maintain the appropriate database to
              conscientious, explicit, and judicious use   know the needs of their patients,
              of current best evidence in making           including texts, proper handbooks, and
              decisions about the care of individual       use of appropriate web sites. Evidence
              patients).                                   based therapeutic issues should be used
        Reviewing patients with resident throughout       as benchmarks. Preceptors are
         rotation in a verbal fashion will assist with     responsible to monitor the use of
         this part of the evaluation. Identify drug        resources and help the resident reach a
         therapy/disease states and any potential          decision. The resident is expected to
                                                           formulate, prepare, and present suggested
         problems. Determine goals and monitoring
                                                           changes in therapy to promote optimal
         plan to achieve those goals                       outcomes.
        Formal Care Plan and CBA Evaluation
         Required (Attach to this Evaluation)              Examples of this process will be formally
                                                           evaluated using CBA.
Goal P3:     Provide concise, applicable,                  Drug information questions, queries,
comprehensive, and timely responses to requests for        analysis, etc, will be the responsibility of
drug information from patients, health care providers,     the resident with guidance by the
and the public.                                            preceptor. Forms for documentation are
                                                           not only useful but required and
                                                           completed forms should be part of the
                                                             resident’s portfolio. Proper sources for
                                                             answering questions are available in the
                                                             clinics and should be used. Delivery of
                                                             the answer to the question must be
                                                             pertinent to the patient situation and to
                                                             the practitioner.
Goal P4:     Document direct patient-care activities         Patient care activities should be recorded
appropriately.                                               on the resident log sheet, in the portfolio,
                                                             and in the institution medical record as
                                                             appropriate. When in doubt ask the
                                                             preceptor concerning the content,
                                                             location for the entry, and procedure for
                                                             doing so. Protocol should be used
                                                             according to the clinic the resident is in at
                                                             the time.

Goal P12: Understand a process for formulating and           Disease prevention and wellness is a
delivering programs that center on disease prevention        priority. The resident should understand
and wellness promotion.                                      the needs of patients by addressing
                                                             educational abilities (sight, literacy,
                                                             interests, needs, dependency on a partner
                                                             in the home, etc.). The resident should
                                                             collect and use teaching guides, expertise
                                                             of others, and deliver education in the
                                                             format the patient is most likely to learn
                                                             (printed material, demonstration,
                                                             modeling, etc.)
Goal M18: Provide instruction to pharmacy                    The resident is not responsible for the
technicians, pharmacy students, pharmacy residents, and      teaching of other residents or
pharmacists.                                                 undergraduate students in pharmacy or
                                                             another discipline. However, sharing
                                                             information, including others in their
                                                             experiences, etc is expected, as is
                                                             necessary for them to succeed.
                      Category 2: Goals Selected to Be Formally Taught But Not Formally Evaluated
    GOALS AND ASSOCIATED OBJECTIVES                        Description of Requirements            NEEDS ATTENTION
Goal S11: Display a caring attitude toward patients in all             The resident considers working with patients a privilege, and considers
aspects of job responsibilities.                                       the patient and their companions guests in the institution. The resident
                                                                       works to assure the patient is as comfortable, as informed, and as cared
                                                                       for as possible. The resident shows the patient respect, and shows
                                                                       compassion and assurance as the patient attempts to succeed in caring for
Goal S12:         Maintain confidentiality of patient and              Patient information, business information, research information and the
proprietary business information.                                      personal information of co-workers are to be protected. Verbal,
                                                                       electronic, written and implied communication of this information is not
                                                                       tolerated and jeopardizes the trust instilled in employees, and the trust
                                                                       built between practitioners and patients. Policy of the institution is to be
                                                                       read, and honored.
Goal M1:     Identify a core library, including electronic media,      The resident will be given guidelines for developing a personal library. In
appropriate for a specific practice setting.                           ambulatory care, this library should be maintained, with emphasis on the
                                                                       patient situations encountered. Presentations attended, presented, and
                                                                   collected should be part of this.
OBJ S3.6          (Synthesis) Develop and implement an             Self evaluation should be a daily practice. The resident should consider
effective system for assessing the quality and accuracy of one's   the contribution s/he has made to the institution and to the staff and
own work.                                                          patients served, and reflect on methods to enhance this in the future.
                                                                   Journaling is encouraged and the journal should be part of the portfolio.
Overall Comments:

Areas of strength (required):

Areas to focus on for enhancement/improvement (required):

_____________________                      _____________________________                                       _____________________________
Resident Signature                         Preceptor Signature                                                 Program Director Signature

Preceptor: Review with Resident, print, sign and give to resident. Also, forward an electronic copy to
Resident: Obtain program director signature, then file hard copy in your residency notebook.

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