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
GOALS AND ASSOCIATED OBJECTIVES
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
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
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
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,
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.
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 email@example.com.
Resident: Obtain program director signature, then file hard copy in your residency notebook.