APPENDIX 1. FOCUS GROUP QUESTIONS 1. Lets introduce ourselves by sharing with the group your name, where you currently practice, and what you enjoy doing when you are not practicing pharmacy; 2. When we say we would like to give students the opportunity to develop skills necessary to provide pharmaceutical care, what five skills come to your mind? 3. What kinds of learning activities will help the students develop these skills? 4. Looking at the list identified in question 2, would it be possible to have students spend 70% of their time in direct patient care activities and 30% of their time in the other activities? 5. Looking at the activities identified in question 2, can you propose the minimum number of each activity the students should complete at the end of week one? 6. Looking at the activities identified in question 2, can you propose the minimum number of each activity the students should complete at the end of week two, three and four? 7. How often should a preceptor and a student meet to review the student s work and progress and to provide feedback? 11
APPENDIX 2. PROPOSED 4-WEEK SCHEDULE Week 1 1. Preceptor to provide student with an orientation to pharmacy staff/ services, review Learning Contract and set expectations (30-45 min) 2. Student to shadow/observe preceptor with pharmaceutical care activities intake of new prescriptions, counseling on new/refill prescriptions, consultation on nonprescription/herbal/ medical devices, follow-up and provision of comprehensive pharmaceutical care 3. Preceptor to observe student participating in 2 of the above activities (1 hour) 4. Student to complete 2 drug information requests 5. Student and preceptor to discuss pharmacy practice issues (anytime during week 1-4) 6. If student will be working on a project, develop a project plan with specific deadlines 7. For comprehensive pharmaceutical care activity, student to interview patient #1, (preceptor may need to observe - 45 min). 8. Preceptor to confirm a visit with a health care provider (home care nurse, physician or community health clinic) or drug company representative (any time during week 1-4). Preceptor to review student s 1 page reflection essay 9. Student to present to preceptor a synopsis on at least 1 nonprescription/herbal category or medical device (10 15 min) Total preceptor time with students: 2-3 hours week 12
Week 2 1. Student to participate in the following pharmaceutical care activities (1-2 hours each day/activity): Intake new prescriptions every morning (minimum of 20/wk) Assess and counsel on new/refill prescriptions from mid-morning to mid-afternoon (minimum of 20/wk) Consult on nonprescription/herbal products and medical devices in the afternoon (8 hrs or 10 patients/week). Student and preceptor to review the care provided 2-3 times a week Provide follow-up two days per week, 2 hours each day (10 patients/week) 2. Student to participate in comprehensive pharmaceutical care activity: Interview patient #2 Complete care plans for patient #1. Student and preceptor to discuss (20-30 min) 3. Student to complete 2 drug information requests per week 4. Student to spend 1 day a week working on project (if applicable) 5. Student to present a synopsis on 1 nonprescription/herbal product or medical device (10-15 min) 6. Student to present a synopsis on 1 therapeutic drug class commonly seen at the pharmacy (10-15 min) 7. Student and preceptor to meet to discuss feedback/formative evaluation (1 hour) 8. Student and preceptor to conduct mid-point evaluation and review Learning Contract (30 min) Total preceptor time with students: 2-3 hours week 13
Week 3 1. Student to participate in following the pharmaceutical care activities (1-2 hours a day/activity) : Intake new prescriptions every morning (a minimum of 20/week) Assess and counsel on new/refill prescriptions from mid-morning to mid-afternoon (minimum of 20/week) Consult on nonprescription/herbal products and medical devices in the afternoon (8 hrs or 10 patients/week). Student and preceptor to review care provided 2-3 times a week. Provide follow-up two days per week, 2 hours each day (10 patients/week) 2. Student to participate in comprehensive pharmaceutical care activity: Interview patient #3 Complete care plans for patient #1 and 2. student and preceptor to discuss patients 3. Student to complete 2 drug information requests per week 4. Student to spend 1 day a week working on project (if applicable) 5. Student to present a synopsis on 1 nonprescription/herbal category or medical device (10-15 min) 6. Student to present a synopsis on 1 therapeutic drug class commonly seen at the pharmacy (10-15 min) 7. Student and preceptor to meet to discuss feedback/formative evaluation (1 hour) 8. Student and preceptor to conduct a mid-point evaluation and review Learning Contract, if not done on week 2 (30 min) Total preceptor time with students: 2-3 hours week 14
Week 4 1. Student to participate in following PC activities (Schedule 1 to 2 hours each day/activity): Intake new prescriptions every morning (minimum of 20/week) Assess and counsel on new/refill prescriptions from mid-morning to mid-afternoon (minimum of 20/week) Consult on nonprescription/herbal products and medical devices in the afternoon (8 hrs or 10 patients/week). Student and preceptor to review the care provided 2-3 times a week. Provide follow-up two days per week, 2 hours each day (10 patients/week) 2. For comprehensive pharmaceutical care activity: Complete care plans for patient #1, 2 and 3, and discuss with preceptor 3. Student to complete at least 2 drug information requests 4. Student to discuss and present/implement/complete their project (if applicable) (30 min) 5. Student to present a synopsis on 1 nonprescription/herbal product or medical device (10-15 min) 6. Student to present a synopsis on 1 therapeutic drug class commonly seen at the pharmacy (10-15 min) 7. Student to complete all their assignments and organize/submit their Learning Portfolio 8. Student and preceptor to complete the final evaluation, review Learning Contract and student s reflection assignment pertaining to the learning that occurred in the rotation (45 min) Total preceptor time with students: 2-3 hours week 15
APPENDIX 3. Preceptor s Evaluation of the Student for Community and Institutional Rotations Score: 1, Unacceptable Score: 2, Minimally Unacceptable Score: 3, Meets Minimal Expectations Score: 4, Above Average Score: 5, Excellent NA, No opportunity Student does not have knowledge of how to perform task. Unable to complete, even with assistance. Requires major improvement. Student has some knowledge of how to perform task. But needs extensive intervention. Sometimes the Preceptor must complete the task. Student has the knowledge & understands process. But does not always apply them consistently and independently without supervision. Requires more than a single prompt from preceptor. Student can perform task independently. Requires only occasional questioning consisting of a single limited prompt. Student can perform in an independent fashion. Never requires any intervention. No improvement needed. Always above expectations. No opportunity to assess student. If, in your judgement, the student is marginal between two categories, please feel free to give a mid-range score. For example, if the student was 3 at mid-evaluation and improved by the end of the rotation but was not meeting 4, it would be fine to assign a 3.5 score. Please support all scorings with an example. Mid Final Dimensions A. Skill & Knowledge 1. Develops a therapeutic relationship with patient (or caregiver) Greets with respect and courtesy Verifies patient s identity For repeat encounters, acknowledges previous interactions Provides a comfortable & private environment to allow for two-way interaction Introduces themselves (name, senior pharmacy student) Explains purpose of interaction & time frame Gives undivided attention If interrupted, apologizes to patient/caregiver for the distraction Use appropriate non-verbal communication (mannerism, eye contact, gesture, interest) Uses appropriate verbal communication (audible tone, rate, appropriate terminology and content) Shows empathy 2. Conducts Interview Collects relevant patient, drug, and disease information Understands relevance of collecting specific patient information Performs patient triage to assess level of care required 3. Identifies Drug-related Problem(s) Interprets and evaluates patient information to identify all drug related problems Provides rationale to support drug-related problems Prioritizes drug-related problems in the order they should be addressed 4. Develops a plan to resolve/prevent drug-related problems 16
a) Determines appropriate therapeutic outcomes b) Develops an appropriate recommendation drug therapy (dose, duration, route) includes appropriate non-drug therapy measures includes additional education/assistance if necessary includes necessary referrals c) Provides rationale for therapy (alternatives) where relevant d) Develops appropriate monitoring plan to assess efficacy and toxicity e) Conducts follow-up in a timely manner (patients receiving pharmaceutical care, OTC consultation, others) 5. Documents intervention using tool provided The Initial care plan, including stating the drug-related problem(s), therapeutic outcomes, alternatives, recommendations, monitoring plan. The Follow-up assessment, including patient s status based on monitoring plan developed. 6. Provides Education & monitoring plan to patient Answers & clarifies questions patients may have had during the interview process Discusses recommendations in clear and concise manner Verifies patient s understanding of information provided Discusses refill status Discusses monitoring plan Discsses process of follow-up 7. Interprofessional Collaboration Uses appropriate oral, written and non-verbal language to obtain and provide accurate and concise information Participates in multidisciplinary team meetings Collaborates with other health care professionals when appropriate to optimize care Understands roles of other health care providers 8. Drug Review Process (reviews medication) Determines appropriateness (indication, safety, and completeness) of order Identifies potential/actual drug-related problems in drug order and profile review Develops appropriate plan to resolve problem(s) Conducts daily drug review of patients on designated nursing unit 9. Knowledge Applies principles of pharmacokinetics to optimize outcomes Demonstrates familiarity with topics taught in the undergraduate program. Discusses disease processes, therapeutic alternatives and develop a pharmacy care plan for these topics. Uses appropriate resources to become familiar with therapeutic areas identified by their preceptors, based on the expectations outlined in the rotation 10. Presentation Communicates information effectively to the audience Uses verbal communication skills effectively Uses non-verbal communication skills effectively Uses audiovisual aids effectively Fields questions effectively Acquires adequate knowledge of non-prescription and prescription products 17
being presented 11. Retrieves and Evaluates Drug Information Establishes the request Selects most appropriate resource(s) for answering the request Answers request in timely fashion Evaluates the quality of information obtained Provides effective verbal and written response to request Prepares written reports on general pharmacotherapy issues, drug therapy controversies and evaluation of drug(s) for formulary review Retrieves, evaluates and manages drug literature searches effectively to support drug information queries, discussions, and pharmaceutical care work-ups 12. Participated in the following site projects effectively: Formulary review Prospective, concurrent, retrospective DUE process Managed care issues (reimbursement) Disease prevention/detection program to public Implementation of call-back program Others: B. Attitude & Professionalism 13. Maintains Professional-Ethical Standards Maintains confidentiality Acknowledges when does not know an answer and is eager to search for answer Modifies behavior in response to feedback Takes steps to ensure accuracy of work 14. Demonstrates Human Relations Skills Is dependable Is sensitive to the needs & feelings of others Listens & is non-judgmental Is tactful 15. Makes Sound Decisions Uses professional judgement in coming up with solutions Seeks and utilizes important facts & information in decision making Recognizes and evaluates available alternatives Gives thought to possible consequences of decisions 16. Organizes/Plans Uses own and others time effectively and efficiently Approaches activities in a systematic and methodical way Sets meaningful goals and confirms goals with Preceptor Plans & prioritizes activities to meet objectives Prepares for all discussions 17. Displays Independence/Assertiveness Uses slack time to research questions & learning issues Is self-directed in undertaking responsibilities Volunteers to participate in in-services and other relevant presentations Shows initiative & motivation when new opportunities present Follows-up on tasks & discussions Completes tasks that have been initiated 18. Learns in a Self-Directed Manner 18
Conducts self-assessment on identifying strengths and weaknesses, develops a learning plan Pursues further knowledge independently Requests for assistance from preceptor when required 19. Communication Makes decisions on own, but confirms with preceptor before acting Articulates viewpoint in a positive & non-threatening fashion Keeps preceptor informed 20. Attendance Arrives at the pharmacy on time Notifies preceptor promptly when delayed or absent, Provides appropriate documentation for absenteeism Stays late to complete task that has been initiated 19
Mid-Point Evaluation I (the student) have reviewed this assessment with my Preceptors and any disagreements have been indicated clearly on the assessment. I understand that final decisions will be based upon the Preceptor s assessment. In order to pass this rotation, I need to: Continue to perform at my current level, or Improve the following (please contact and send a copy to the Clerkship Director) Preceptor s Signature Student s Signature Date Date Final Evaluation Overall Preceptor s Comments: Feedback given to student # of days absent from clerkship rotation. Documentation provided: Yes / No. Missed days made up: Yes/ No. Weekly shift consisted of hours/ day; days per week Did student contact the preceptor at least 1 month prior to start of the clerkship: Yes / No Preceptor s Signature Date Student s Signature Date 20