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MENU OF PRECEPTORS’ FEEDBACK & EVALUATION COMMENTS

Positives > pp 1 - 5

Improvements needed > pp 5 - 9

Recommendations > pp 9 - 10

General > pp 11- 12

POSITIVES

Appropriate Medication Use

• Identified important medication therapy issues for patients with chronic mental health conditions residing in the group home setting.

• You made a great catch to prevent an inappropriate drug getting to a patient!

Clinical pharmacology

• He did an excellent job reviewing pharmacology of the drugs that his patient was on and was able to provide information to the team about some medications.

• Impressive knowledge for first clinical rotation.

• Good improvement in knowledge of drug products, pharmacology, & mechanism of action for drug classes.

• She brought a very high baseline knowledge to this rotation that is helping in her ability to apply the knowledge of pharmacy school to her patient.

Communications, Oral

• By the end of the rotation, it was obvious how much the physicians and medical students on the team valued their opinions and recommendations.

• He excelled at handling interactions with physician offices, counseling patients, and working with other members of the pharmacy staff.

• He works well with all staff and has excellent communication skills when talking with patients.

• He seems to work well with the health care team and is assertive in asking questions to clarify information as needed.

• I was very pleased with the relationships she was able to establish with her medical team.

• Organization and flow of patient presentations improved throughout the rotation.

• She communicated often with me in terms of the status of her projects and worked very hard on the research project.

• She has been prepared for the pharmacotherapy discussions and engages in discussion of cases.

• She is still quiet in a group setting but did make some efforts to interact with the team with problems that she identified and was able to interact with other HCP on a one to one basis.

• She tends to be very quiet, but participated well during topic discussions.

• She was able to make recommendations to the team that enabled for a positive patient impact.

• Very confidant when speaking with patients, preceptors, medical staff, etc.

Communications, Patient/Caregiver

• Although nervous in the beginning, he quickly gained confidence and was able to effectively interview patients.

• By the middle of the rotation he was able to thoroughly and confidently discuss medications with our patients. By the end of the rotation he was able to organize his counseling technique so that he could be thorough but also efficient.

• Great communications and interaction with patients.

• He has a good knowledge base, communication skills, and experience in the community setting that aided him during the several flu clinics, blood pressure screenings, and health screenings he was assigned to participate in.

• He has gone above and beyond when counseling patients by obtaining patient assistance program information as well as making a picture based educational handout for a patient who couldn't read.

• He has provided patients with medication lists and counseling on medications as requested.

• She is very hard working and exhibited great care for her patients.

• She performed numerous patient-counseling sessions about diabetes, medication adherence, and Coumadin/Lovenox.

• Student did a good job recommending OTC products to patients during counseling.

• When counseling patients, she is very good at covering the information.

Communications, Written

• Good job with comprehensiveness of notes/including all pertinent information.

• His notes improved immensely over the rotation so much so that at the end very little to no additions needed to be added.

• Organization of notes in SOAP format and organization of information within each note improved gradually.

• She has made wonderful sheets for patient med lists, and great topic sheets for our discussions.

Critical Thinking/Decision-Making

• He has demonstrated the ability to work through a problem from evaluation to synthesis of a resolution by using appropriate resources.

• She is demonstrating that she possesses the necessary skills to problem-solve.

Disease State Knowledge

• Disease state knowledge at baseline is good and I know that she has taken steps to independently look up additional information as she has run across information that she is not familiar with.

• She was able to form a strong foundation on many disease states by participating in topic discussions regarding Asthma/COPD, heart failure, hypo/hypernatremia.

Dispensing

• Student is able to make compounds, order entry, dispense and other tasks associated with patient care.

Health Promotion

• He provided counseling to patients and employees about healthy lifestyles for disease prevention, health promotion, and public health, that were helpful, accurate, appropriate, and complete.

• You successfully performed point of care testing such as cholesterol and BP measurements.

Informatics/Evidence-Based Pharmacotherapy

• He has good skills in retrieving information from the computer.

• Great job utilizing the computer system quickly.

• She has demonstrated the ability to navigate the computer system for patient related information and also primary literature and guidelines.

Management

• She did a very find job completing compliance reports and conducting several audits.

• Some of the projects she was involved in were updating the Immunization Vaccine Chart, reviewing for the Board of Pharmacy Inspection, and Policy and Procedures.

• He was exposed to topics reviewed at the Pharmacy Committee meetings, CQI, management, inventory, budget and end of the month reporting.

Patient Information

• ABC has shown great enthusiasm in learning how to interpret laboratory values.

• Good job collecting information from patient interview and during your pre-rounding – very thorough.

• Great job reviewing past clinic notes to obtain a good understanding of what's been going on with the patient, external RX histories, future clinic appointments.

• One of her strengths is her organization in patient information and notes, which has led her to be efficient during rounds and patient presentations.

• She is able to interview patients in a time efficient manner and is able to skillfully obtain most of the information needed in order to develop a patient centered plan.

• She is able to focus in on the most pertinent information vs. extraneous information.

Patient Pharmacotherapy Assessment

• I have already seen an increased growth throughout this rotation in her knowledge and ability to apply that knowledge.

• I’m seeing some improvement in her performance and therapeutic knowledge.

• It is evident that she prepares for her patient visits by reviewing some of the last few notes, reviewing the patients' meds, and identifying and potential drug-related problems.

• She is demonstrating improvements in her ability to make decisions for pharmacotherapy recommendations and implementation with continued practice.

• She provided great insight on areas for improvement with these patients and has assisted in counseling some of the patients with issues.

• When evaluating drug-related problems, she considers all aspects of the patient and their conditions.

Pharmaceutical Product Knowledge

• He excelled in the areas of product knowledge, drug dosing, and contraindications.

• He is able to recall dosage forms of medications that he is encountering and is able to determine when they are appropriate.

• She has frequently demonstrated her knowledge of pharmaceutical products (especially with regards to intravenous/infusion products as evidenced by previous experience as an intern).

• XYZ has learned a lot about the different medications in our setting, including HIV, Hep C, TB exposures, and antibiotics.

Pharmacy Care Plan

• He continued to grow in his ability to put together a patient care plan.

• He offered many good recommendations that were usually accepted by the respective prescriber.

• He was involved in MTMs and very thorough in his research of the patient and medications.

• She has taken feedback from her midpoint and applied it to improve her patient management skills.

• SOAP notes are generally complete and include an appropriate level of detail.

Pharmacy Profession/Professionalism

• ABC has been actively engaged and has a strong work ethic.

• ABC quickly found her role in clinic as a pharmacy practitioner, independently seeing patients and always interacted appropriately with other disciplines (medical attendings, students, etc).

• Even when faced with difficult hard to manage patients, he maintained his composure.

• He effectively applied feedback from his midpoint evaluation.

• He functioned as a professional with compassion and took on all assigned tasks with a positive attitude.

• He has a great perspective and will have a positive contribution to the profession. He was open to new ideas and concepts, asked insightful questions, and completed all tasks on time. He interacted with everyone in the organization very well and will be missed.

• He is very professional in his approach to patient care and adaptable to different environments, which are key attributes to be successful in pharmacy.

• He is very professional, more mature than most students that I have precepted, demonstrates concern for patient's wellbeing, and respects the patients, families, and colleagues.

• He works well in team environment.

• He's been proactive in submitting assignments in a timely fashion and asking for additional work when he completes assigned tasks.

• She carries herself in a professional manner in the patient care setting.

• It was a great pleasure to have XYZ on rotation. Her enthusiasm spreads easily to me and to her patients!

• She is engaged in her learning.

• XYZ’s work ethic has not been a concern at all. He is very motivated and eager to learn/assist.

• ABC has taken a lot of initiative in the second half of the rotation.

Prescription Verification

• He jump-started our immunization program.

• He was quite accurate in verifying prescriptions.

• His performance in handling the flow of dispensing, answering questions, counseling and researching information when necessary showed that he has what it takes to be a caring, competent and successful pharmacist.

• She has done exceptionally well communicating with physicians, receiving and verifying prescriptions, compounding, and counseling patients.

• She was very proactive while processing prescriptions and always prepared to ask questions about drug therapy issues as well as pharmacy law. This attention to detail early in her career is very impressive and will provide a nice foundation for future rotations and eventually the practice of pharmacy. For example, we recently had a post-MI patient who received a stent bring in six prescriptions. She noticed that there was no prescription for Plavix that is standard protocol for patients being discharged after stent placement. She counseled the patient and it turned out that he had been given samples. This kind of thing sets her apart from her peers.

• You are clearly comfortable with accurately distributing prescriptions.

• Your methodical approach to reviewing and dispensing new prescriptions was laudable, and your previous experience shows.

Presentations/Projects

• Great job systematically presenting each problem by problem.

• He assisted Medicare-D patients in navigating several plan options during the open enrollment period.

• He completed a very thorough DUE on antibiotic usage at our site and prepared an in-depth presentation on antibiotic stewardship with handout to help our clinicians better utilize antibiotics. This has been tremendously helpful.

• Her final case presentation was well researched and the presentation well developed.

• His final presentation was excellent and was perhaps the pinnacle of his rotation: thoroughly researched, perfectly organized; lot of supporting literature, went through the patient's admission history with a fine-toothed comb; and received very positive feedback from colleagues.

• His research to determine our USP 797 compliance and our readiness for the Board of Pharmacy's inspection was impressive.

• Presentations were comprehensive, yet focused on the most relevant information. Projects were always completed in a timely manner, even before the assigned due date.

• She completed a very nice patient friendly brochure for our pharmacy to use when patients ask about VTEs.

• She co-presented a topic presentation on Medicare D, and developed pharmacist-counseling sheets on emergency contraception and OTC medications for use in pregnant women. She created a brochure on promoting health screenings in the community.

• She gave one presentation on chronic asthma management to fellow students, and her journal club was concise and the article well evaluated. She is organized and thorough with her work assignments, especially the HTN project.

• She was quick to incorporate suggestions made for improvements into the next presentation.

• The Epi-Pen quick reference sheet he created for a health fair we attended was well received by the school nurse that requested it and will be used in the future by the school.

IMPROVEMENTS NEEDED

Appropriate Medication Use

• Overlooked an important drug allergy in a patient; but will surely be more attentive as he becomes more familiar with organization of the patient’s records.

• When compiling a current medication list for an elderly patient, the drug name, strength, route, and dosage frequency were accurate, but she failed to identify the multiple prescribers.

• Will learn from the experience of missing a duplication of therapy pre-hospitalization when preparing a new prescription provided at hospital discharge.

Clinical pharmacology

• ABC’s pharmacology knowledge is comparable to other students at this stage in the program, but as with all students, should be an area of focus for the remainder of the rotation.

• Although this is the first rotation, progress is slower than expected. Will work with her to better anticipate drug information questions and analyze multiple streams of information.

• Her confidence regarding drug information is low; however, her true level of understanding is often very good.

• In general he has good clinical instincts but needs to solidify his knowledge base with more intensive review of pharmacotherapy.

• Increased confidence in her knowledge and commitment to engage in team discussions are needed for the rest of the rotation.

• It is important to look up the medications, how they work, what we monitor for use, and how long we would utilize it for.

• Very limited knowledge of pharmacology: Unable to explain mechanism of action, common adverse effects, common dosing of many medications. However, is able to retrieve this information from resources when asked.

Communications, Oral

• She has been able to ID potential interventions but I would like her to be more proactive in asking the team about these interventions.

• I sometimes feel she is hesitant to speak up. If she would do so, her performance and assessment would be much better than reflected now.

• She has good communication skills and had made some suggestions; however, I would like her to be more proactive in bringing up potential interventions to me so she can make interventions to other HCP [health care professionals].

• She needs to continue to work on being more outspoken.

• Sometimes it seems like she knows an answer and just is scared to be wrong.

• Let me hear from you more! You are exceedingly polite but would like you to be more proactive.

• She is quiet and shy at times.

• It is also important to watch how you communicate to others. I have received reports that you can come off "cocky".

• There are times on rounds that you make inappropriate questions/comments regarding a patient that is not yours.

• She is sometimes too soft spoken.

Communication, Patient/Caregiver

• At times, ABC presents incorrect and inaccurate information to myself and to patients. There have been occasions where I had to correct.

• Does not communicate clearly or slowly. Does not verify that patient understood instructions. At times, gives incorrect information.

• I highly encourage you to really focus on patient care and take time to understand treatment guidelines to make appropriate recommendations and be certain of an answer before replying to the patients in order to prevent providing patient with false information which can create for a dangerous situation.

Communications, Written

• Continue to be mindful of grammar and spelling, keeping in mind that notes written are a permanent part of the patient's medical record.

• I would encourage him in the future to work on making handouts more concise and consistent.

• It is inappropriate for a student to post disparaging remarks about her rotation on Facebook.

Critical Thinking/Decision-Making

• Continue to work on critical thinking skills and developing ability to analyze patient information and synthesize your own plan for each patient.

• He has basic integrative skills but would like him to work on advancing these skills in regard to individual patients.

• She struggled at times to synthesize information from multiple sources.

• Try to "look ahead" when thinking about each patient's case to anticipate what may happen and how your plan would change.

• Work to be able to anticipate questions and prepare in advance when there are deficits in your knowledge.

Disease State Knowledge

• It is important to know about disease states to understand what appropriate treatments are and what we look for, and that different diseases are treated differently.

• She still needs to look quite a few things up, but when she looks up information, she retains it quite well.

• Very limited knowledge of disease states: Continue to expand by researching topics/disease states that you are not as familiar with.

Dispensing

• You must very carefully and methodically select the right drug product and strength to avoid dispensing errors.

Health Promotion

• Does not focus on the patient as a whole and makes very little intervention in regards to methods to promote overall health.

• When a patient has diabetes or hypertension and is notably non-compliant, make sure to talk about the disease and what may happen to them if they are not compliant with treatment.

Informatics/Evidence-Based Pharmacotherapy

• Instead of using Google as the first source, use reliable health care resources from which to obtain information.

• Use primary literature instead of tertiary resources.

Patient Information

• Conduct a full medication history for each patient, utilizing open-ended questions to evaluate patients' knowledge of their medication regimen.

• Don’t overlook pertinent diagnostic tests.

• On multiple occasions, pertinent lab info has been missed; e.g. ….

• Reconcile differences between what the patient is saying and what is documented in the medical chart.

• Was better at looking up morning labs, but still needed the occasional reminder to look up the 24hr trends on things like blood glucose.

Patient Pharmacotherapy Assessment

• Does not explain reason for recommendations.

• Does not refer to guidelines often.

• Don’t just repeat what the team is doing … the team is not always appropriate in what they are planning.

• It is important to note what you want to do, why you want to do it, and how are we going to monitor it.

• She is becoming proficient in identifying problems; however, she is still developing the skills needed to research and formulate a solution.

Pharmaceutical Product Knowledge

• Look at some of the various formulations for products as that can make a difference in patient use and acceptance, e.g. nebulized vs inhaled medication.

• Was unable to identify method of administration of certain products (i.e. Imitrex inj).

Pharmacy Care Plan

• ABC is still developing and improving her knowledge of disease states, pharmacology, assessment of patients and developing care plans.

• At times, recommendations are incorrect or unreasonable.

• As we discussed, there should be no new information in the A/P that hasn't already been presented in S&O [subjective & objective].

• Continue to work on committing to a plan (with rationale) and go for it e.g. being clear about your recommendation re the need for simvastatin in your patient with DM & LDL 85mg/dL.

• Does not specify therapeutic endpoints or monitoring for efficacy/toxicity consistently.

• Does not assess necessary labs often.

• He is proficient in using information presented to him to formulate a plan and potential consequences, but is still developing the skills needed to find and utilize the appropriate guidelines and primary literature.

• She still has needed prompting in thinking about monitoring parameters that we need to follow up on.

• She is very congenial but also unsure of her skills. At times this uncertainty paralyzed her causing her to be unable to formulate a plan for patients.

• Think more about what we need to do, why, and how we monitor it.

• XYZ is learning how to assess and respond to developments at the practice site.

Pharmacy Profession/Professionalism

• Asking for multiple times off is inappropriate. You asked off one afternoon which was granted; but then asked off another afternoon which was rejected. Asking off should be an exception for good cause and not appear to be a pattern.

• Be more accountable and confident for your pharmacy knowledge and actions.

• Despite personal relationships with others within the work environment, it is important to stay professional at all times and to work independently when asked to do so.

• Find out how your preceptor feels about texting. I am personally ok with some texting because it can be an easy way to get in touch with people, but there is an extent to which it is appropriate. Texting a preceptor to ask to not round is an example of things that are not appropriate. Texting your friends is not appropriate during rotation hours. Texting to say you will be late due to illness or car accidents would normally be appropriate.

• It often appears as if you would rather be somewhere else, so we will monitor your engagement more during the remainder of the rotation.

• Some times she reacts negatively to preceptor's feed back.

• You need to continue to work on reading directions and getting things in on time to the correct person.

• You need to work on following up and completing assigned items. Multiple things you were asked to look up were not completed in a timely manner.

• Your improvement has to be more profound than you have shown to my staff or me. You need to be taken seriously by staff first which will then translate to patients.

• You’ve struggled with time management and allowed yourself to feel overwhelmed before finally addressing the issue with me.

• You need to work on meeting deadlines. Multiple times you missed deadlines you knew about.

• XYZ was 1.5 hours late for his rotation during his first week due to oversleeping. We discussed this being an ‘exception’ rather than a ‘standard’ measure of acceptable conduct. He made up the time by staying late. He also had car trouble causing him to be 5 hours late one time. He notified me promptly of the delay and made up for the missed hours.

Prescription Verification

• As we have discussed, more focused attention to details and greater familiarity with drug products (names, doses, routes, appropriate use, etc) are clearly needed.

Presentations

• Although she was given pointers and advice on how to improve her presentation prior to its presentation, very little changed and she was unable to answer questions she was prepped for.

• On the project she was satisfied to let her student partner perform the bulk of the work because she was unsure of her own ability.

• She needs to work on her public speaking and looking up pronunciation prior to giving a presentation.

• You did a great job preparing for your in-service, but more practice ahead of time should have lessened your nervousness and avoided stumbling over some words. These are all areas which you should have no trouble improving.

• You seem quite comfortable (or appears so) in answering questions about your presentations but seem very uncomfortable giving the presentation (you read most of it).

RECOMMENDATIONS

• ABC should focus on anticipating drug information questions and disease state issues.

• Always review your patients’ medications to ensure the proper dose, dose adjustments, AE's, and monitoring parameters.

• As she gains more experience, ABC will not only increase her pharmacotherapy knowledge base, but also be able to work more efficiently at developing care plans for her patients thus implementing her recommendations with more confidence.

• Be more assertive in your self-directed learning to better retain info and improve her clinical confidence.

• By increasing your baseline pharmacology knowledge, you will are better able to make more informed decisions and recommendations for adjustments to or additions to your patients pharmacotherapy.

• Continually evaluate patients' drug regimens for optimization.

• Continue to be mindful of grammar and spelling, keeping in mind that notes written are a permanent part of the patient's medical record.

• Continue to expand your drug and disease state knowledge and look things up in the morning and at home to ensure you understand both drugs and diseases … to help ensure appropriate and effective patient care and best treatment for the patient.

• Continue to seek out opportunities for patient counseling/health promotion (ex. nutritional recommendations for patients with DM, lifestyle modifications for HTN/DM, smoking cessation, weight loss) and tailor recommendation to patient specific needs

• Continue to stay motivated and willing to learn.

• Continue to work on critically thinking about each aspect of the patient's care.

• Continue to work on your patient presentation skills as discussed with organization of your patient history, establishing a problem list, and recommendations complete with monitoring parameters.

• During the next two weeks we will focus on the dispensing functions to improve upon her knowledge base of community pharmacy.

• He has great communication skills when talking to patients but I would encourage him to try to utilize the teach-back method in order to insure understanding from the patient.

• I encourage you to work on increasing your eye contact and confidence when providing pharmacy recommendations.

• In future rotations, she should be encouraged to commit greater time to reviewing drug therapy topics rather than assume that all learning will happen during the day.

• Review all pertinent labs, diagnostic tests, other non primary care clinic notes, etc.

• Try to "look ahead" when thinking about each patient's case to anticipate what may happen and how your plan would change.

• I encourage you to identify areas where you can augment medication counseling with some disease state information. For example, when a patient has diabetes or hypertension and is notably non-compliant, make sure to talk about the disease and what may happen to them if they are not compliant with treatment.

• I fully expect much better scores at the end of the rotation if things continue to progress as they have been.

• Read, read, read to gain additional insight into pros/cons of various options and evidence supporting each recommendation.

• When presenting patients, continue to work on developing a systematic presentation flow (e.g. why the patient is being seen today, briefly what happened at the last visit, and today: S-O-A-P).

• You should ensure that you are always prompt. Learn quickly to adjust commute time to accommodate morning traffic.

GENERAL

• A real go-getter!

• Actively strives to obtain new knowledge.

• All assignments still need to be completed prior to the completion of the rotation.

• Although she is receiving a failing grade at midpoint, I anticipate her overall performance and grade will improve as she progresses through this rotation.

• Although she was confident and competent, she very much encouraged feedback for improvement.

• Although you are at the site from 9 to 5, you need to work on ______ outside of that time.

• Continue the great work!

• He always has a positive attitude and is coming in early and staying late.

• He got better through the rotation in questioning things and wanting to know more.

• He has grown as a student over the past 5 weeks … it was almost as if a light bulb came on during the third week of rotation.

• He has shown himself fully capable as a pharmacist I would be glad to work beside.

• He has very much improved during this rotation.

• He is always willing to look up information he does not know and teach it to the rest of us.

• He is progressing at the rate that I would expect and in some ways is much farther along than I would expect.

• He learned the specifics of our site and contributed some ideas of his own to add to our practice.

• He makes a great addition to the team. His high level of efficiency and accountability on this rotation has been very impressive.

• Her confidence and ability to speak with all patient populations has greatly improved.

• Her personality is very easy to get along with and I think her easy going manner will suit any environment that she chooses.

• He was extremely good with patients in helping them with whatever they needed, interacted well with employees and other healthcare providers and learned fast.

• He was superb in all areas of the rotation including dispensing, health screenings, flu clinics, presentations, and drug information.

• His projects were very well organized and presented very professionally.

• I would gladly recommend him for a position if asked to do so in the future.

• I wish him all the best in the future and know he will continue to develop this year and be an excellent pharmacist.

• I am very impressed with your dedication and hard work during this rotation.

• I wish you luck in all your future endeavors.

• It is important to recognize verbal and non-verbal aspects of professionalism.

• It was a pleasure to work with XYZ on this rotation. I wish her great success in her career.

• Over the course of this rotation you have greatly improved in both knowledge and confidence.

• Overall, ABC has improved in every area from the midpoint and I was extremely pleased with his initiative and performance on the rotation.

• Professional, courteous, & receptive to learning and suggestions.

• She always performed each task and assignment very methodically.

• She comes to rotation prepared and with a positive attitude.

• She excelled in most of her exams, her assistance with our BP clinic was immeasurable, and her bedside manner is to be commended. I feel she will make a great addition to the profession.

• She has a good work ethic and takes initiative.

• She has a great attitude and work ethic.

• She has demonstrated consistent improvement throughout the first-half of her rotation, but still has room for continued growth in most areas.

• She has exemplified great skill in all the point of care services.

• She identified several goals for this rotation including expanding her understanding of the pathophysiology behind common disease states, improving her knowledge of antibiotics, recall and better evaluate risk factors for certain conditions, identify the most common side effects of medications, and identify which labs need to be monitored after initiating drug therapy. She is making great strides towards accomplishing these goals.

• She is a very approachable person and patients are at ease with her.

• She is engaged in her learning.

• She possesses the ability to form adequate and trusting patient-pharmacist relationships.

• She shows great initiative to solve problems and goes above-and-beyond what is asked of her!

• She takes both her learning and her patients seriously.

• She will do well as a clinician if she continues to work hard to improve her skills for the remainder of her rotations

• She was confident in her work and very thorough.

• Student shows potential of being a good pharmacist.

• This is her first rotation, so I am confident that she will continue to improve throughout the year.

• Very mature and energized toward the profession.

• Wants to learn. Self-starter

• With more experience, I am fully confident of your abilities to be a great clinical community pharmacist!

• XYZ has demonstrated a self-motivated interest in learning which is essential to becoming a competent professional.

• You have been a pleasure to have on rotation.

• You have been a wonderful student and I have no doubt that you will be an excellent pharmacist.

• You have done a good job on the rotation thus far.

• XYZ continued to progress on this rotation. I could not have asked for someone who took suggestions and incorporated them better than she did.

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