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 Evaluation 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 timely. 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 themselves. 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 firstname.lastname@example.org. Resident: Obtain program director signature, then file hard copy in your residency notebook.
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