HIV Clinic



UNIVERSITY HEALTH NETWORK/ McGILL UNIVERSITY HEALTH CENTRE HIV ADVANCED (YEAR 2) RESIDENCY PROGRAM

THERAPEUTIC DRUG MONITORING ROTATION - RESIDENT ASSESSMENT FORM

REPORT COVERS PERIOD FROM:_________ TO ____________

NAME OF RESIDENT: _______________ NAME OF PRECEPTOR: ________________

COMPLETED BY: Preceptor _____ Resident _____ (check one) THIS IS A ___ MIDPOINT OR _____ FINAL ASSESSMENT (check one)

Preceptor: I reviewed the Clinical Longitudinal Assessment Form at the start of the rotation: Yes _____ No _____ (check one)

I reviewed the resident’s personal learning objectives at the start of the rotation: Yes _____ No _____ (check one)

ROTATION OUTCOMES:

The resident will develop the clinical knowledge, skills, and professional values to:

A. Interpret antiretroviral plasma concentrations and make recommendations to optimize therapy

B. Provide medication- and practice-related education

C. Manage one’s own practice of pharmacy

D. Lead a therapeutic drug monitoring (TDM)-related project

KNOWLEDGE CONTENT:

In this rotation the following drugs, disease states and clinical skills were discussed:

|Drug therapy and Disease State |Clinical Skills |

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|Medication knowledge (PK/ PD |□ |□ |□ |□ |□ |□ |

|properties and relationships |Inadequate fund of knowledge to |Superficial fund of knowledge to|Satisfactory fund of knowledge |Substantial fund of knowledge to|Exceptional fund of knowledge to| |

|of antiretrovirals (ARV), |apply to the interpretation of |apply to interpretation of TDM |to interpret effectively most |interpret consistently and |interpret consistently and | |

|factors that influence PK |TDM results at the designated |results at the designated level |TDM results at the designated |effectively all TDM results at |perceptively all TDM results at | |

|variability for a given ARV) |level of performance* |of performance. |level of performance. |the designated level of |the designated level of | |

| | | | |performance. |performance. | |

|Justify your rating using concrete examples: |

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|Therapeutic drug monitoring |□ |□ |□ |□ |□ |□ |

|(TDM) knowledge |Inadequate fund of knowledge to |Superficial fund of knowledge to|Satisfactory fund of knowledge |Substantial fund of knowledge to|Exceptional fund of knowledge to| |

| |describe the literature that |describe the literature that |to describe the literature that |describe precisely and |describe precisely and | |

| |supports antiretroviral TDM. |supports TDM. |supports antiretroviral TDM. |effectively the literature that |effectively the literature that | |

| | | | |supports antiretroviral TDM. Is|supports antiretroviral TDM. | |

| | | | |able to identify some |Able to describe adequately all | |

| | | | |limitations of antiretroviral |limitations of antiretroviral | |

| | | | |TDM. |TDM. | |

|Justify your rating using concrete examples: |

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|Ethical, Legal and Standards |□ |□ |□ |□ |□ |□ |

|of Practice Knowledge |Inadequate funds of knowledge in|Superficial funds of knowledge |Satisfactory funds of knowledge |Substantial funds of knowledge |Exceptional funds in all three | |

| |any or all three domains to |in any or all three domains to |in all three domains to practice|in all three domains to practice|domains to practice consistently| |

| |practice within appropriate |practice within appropriate |within appropriate perimeters at|within appropriate perimeters at|and perceptively ensuring best | |

| |perimeters at the designated |perimeters at the designated |the designated level of |the designated level of |practices at the designated | |

| |level of performance. |level of performance. |performance. |performance. |level of performance. | |

|Justify your rating using concrete examples: |

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*Designated level of performance = at the end of the rotation the resident will be able to independently interpret plasma concentrations from moderately complex cases. Moderately complex problems have either complex drug related knowledge required (ie. drug resistance, genotypic inhibitory quotients) or involves special populations (ie. pregnancy, pediatrics, hepatic impairment, etc).

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|Calculating and choosing pertinent|□ |□ |□ |□ |□ |□ |

|PK / PD parameters (Cmin, GIQ, |Fails consistently to calculate|Has difficulty calculating |Appropriately calculates most |Appropriately calculates most |Consistently calculates | |

|wGIQ, vIQ, IIP) |the PK/PD parameters correctly.|PK/PD parameters. Many results|PK/PD parameters. Shows some |PK/PD parameters. For most |correctly all PK/PD parameters.| |

| |Is unable to choose the |are inappropriate. Often is |difficulties in choosing the |cases, chooses the best PK/PD |Always chooses the best PK/PD | |

| |pertinent PK/PD parameters for |unable to choose the pertinent |best PK/PD parameters for |parameters for specific |parameters for specific | |

| |specific situations. |PK/PD parameters for specific |specific situations. |situations. |situations. | |

| | |situations. | | | | |

|Justify your rating using concrete examples: |

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|Data analysis |□ |□ |□ |□ |□ |□ |

| |Fails to discern relevant from |Discerns some relevant clinical|Discerns sufficient relevant |Discerns most relevant clinical|Precisely discerns the relevant| |

| |irrelevant clinical data; |data, but not enough to allow |clinical data to allow |data and seeks at times |clinical data and often seeks | |

| |significant data is overlooked |appropriate decision making. |appropriate decision making. |supplementary data (ie: viral |supplementary data (ie: viral | |

| |and/or difficulty is |Some significant data may be | |load, CD4+, biochemistry, |load, CD4+, biochemistry, | |

| |experienced in interpreting the|overlooked or misinterpreted. | |resistance). Integrates most |resistance). Weighs | |

| |available data. | | |data appropriately. |alternatives, justifies | |

| | | | | |choices, synthesizes and | |

| | | | | |integrates all data correctly. | |

|Justify your rating using concrete examples: |

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|Clinical Decision making |□ |□ |□ |□ |□ |□ |

| |Often poor clinical judgement, |Sometimes shows poor clinical |Shows good clinical judgement |Good clinical judgement and |Excellent clinical judgement. | |

| |difficulty in arriving at |judgement; some difficulty in |and usually makes sound |problem solving skills. Is |Consistently arrives at right | |

| |correct decisions; fails to |decision making. |decisions; needs assistance for|able to interpret TDM results |decision even in complex cases.| |

| |make use of content knowledge | |more complex cases. |appropriately for most complex | | |

| |and all available information. | | |cases. | | |

|Justify your rating using concrete examples: |

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|Develop a Therapeutic Plan (TDM |□ |□ |□ |□ |□ |□ |

|recommendations) |Recommendations are incomplete |Recommendations are frequently |Recommendations are usually |Recommendations are complete, |Recommendations are | |

| |or inappropriate; |incomplete or superficial. Has |complete, appropriate, and |appropriate, reflect the |consistently complete, | |

| |Recommendations are never |difficulties justifying the |reflect the current standards |current standards of practice |appropriate, reflect the | |

| |justified appropriately. |recommendations. |of practice. Recommendations |and are presented in a logical |current practice and are | |

| | | |are often justified. |manner; most recommendations |presented in a logical manner; | |

| | | | |are justified and referenced |all recommendations are | |

| | | | |when appropriate. |justified and referenced when | |

| | | | | |appropriate. | |

|Justify your rating using concrete examples: |

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|Establish and implement |□ |□ |□ |□ |□ |□ |

|monitoring/follow-up plan |Recommendations rarely or never|Recommendations sometimes |Recommendations include a |Recommendations include a |Recommendations include a | |

| |include a follow-up plan. |include a follow-up plan. |follow-up plan. Plans are |follow-up plan. Plans are |follow-up plan. Plans are | |

| |Plans are incomplete or |Plans are frequently incomplete|usually complete, appropriate, |complete, appropriate, and |consistently complete, | |

| |inappropriate; significant |or superficial; some |and reflect the current |reflect the current standards |appropriate, and reflect the | |

| |monitoring parameters are |significant monitoring |standards of practice; most |of practice; all monitoring |current practice; all | |

| |overlooked. |parameters may be overlooked. |monitoring parameters are |parameters are correctly |monitoring parameters are | |

| | | |correctly identified. |identified. |correctly identified, | |

| | | | | |strategically considering all | |

| | | | | |aspects of patient care and | |

| | | | | |logistics. | |

|Justify your rating using concrete examples: |

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|TDM documentation (e.g. written |□ |□ |□ |□ |□ |□ |

|interpretation reports) |Often inaccurate, incomplete, |Sometimes inaccurate, |Usually accurate, complete, |In most cases, accurate, |Consistently accurate, | |

| |disorganized and/or confusing; |incomplete, disorganized and/or|adequately organized and |complete, adequately organized |comprehensive, coherently | |

| |almost always difficult to |confusing; many reports are not|referenced and presented in a |and referenced, and presented |organized, concise, and | |

| |understand. |presented in a clear, |clear, understandable way. |in a clear, concise, and |referenced; excellent command | |

| | |understandable way. | |understandable way. |of expression. | |

|Justify your rating using concrete examples: |

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|TDM queries (content) |□ |□ |□ |□ |□ |N/A |

| |Often provides inaccurate and |Sometimes provides inaccurate |Usually provides accurate and |In most cases provides accurate|Consistently provides accurate | |

| |incomplete TDM-related |and incomplete TDM-related |complete TDM-related |and complete TDM-related |and comprehensive TDM-related | |

| |information to health care |information to health care |information to health care |information to health care |information to health care | |

| |professionals. Responses to |professionals. At times, |professionals in a timely |professionals in a timely |professionals in a timely | |

| |questions are not given in a |responses to questions may not |manner. May require some |manner and with little to no |manner and with little to no | |

| |timely manner. |be given in a timely manner. |assistance for complex cases. |assistance. |assistance | |

|Justify your rating using concrete examples: |

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|C. COMMUNICATION SKILLS |

|Communication with: |□ |□ |□ |□ |□ |□ |

|Caregivers |Often difficult to follow |Sometimes superficial, rambling|Usually adequately organized |In most cases appropriately and|Precisely focused, coherently | |

|Other pharm. and staff |and/or hard to understand |and not always understandable |and understandable and |effectively focused, organized |organized, clearly and | |

| |and/or inappropriate for the |or inappropriate for the |appropriate for the specific |and delivered; consistently |succinctly expressed and always| |

| |specific individual(s). |specific individual(s). |individual(s). |clearly expressed and |appropriate for the specific | |

| | | | |appropriate for the specific |individual(s). | |

| | | | |individual(s). | | |

|Justify your rating using concrete examples: |

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|Oral presentation |□ |□ |□ |□ |□ |□ |

|presentation skills, style, & |Often incomplete and/or |Sometimes incomplete and/or |Usually complete and accurate, |In most cases appropriately, |Precisely focused, coherently | |

|content |inaccurate, difficult to follow |inaccurate, superficial, |adequately organized, and |comprehensively and effectively|organized, accurate and | |

| |and/or hard to understand and/or |rambling and not always |understandable and appropriate |focused, accurate, organized |comprehensive, clearly and | |

| |inappropriate for the specific |understandable or inappropriate|for the specific audience. |and delivered; consistently |succinctly expressed and always| |

| |audience. |for the specific audience. | |clearly expressed and |appropriate for the specific | |

| | | | |appropriate for the specific |audience. | |

| | | | |audience. | | |

|Justify your rating using concrete examples: |

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|D. PROGRAM MANAGEMENT / DEVELOPMENT (TDM-related project) |

|Project |□ |□ |□ |□ |□ |□ |

| |The TDM-related project is not |Completes the assigned |Completes the assigned |Completes the assigned TDM – |Completes the assigned | |

| |completed during the rotation. |TDM-related project during the |TDM-related project during the |related project during the |TDM-related project during the | |

| |The resident is not motivated |rotation but with difficulty. |rotation and shows some |rotation without difficulty. |rotation easily and for the | |

| |or interested in the project. |Needs substantial assistance. |motivation and interest for the|Shows substantial motivation |most part independantly. Shows| |

| |The quality of the work is |Is not always motivated or |project. The quality of the |and interest for the project. |excellent motivation and | |

| |poor. The resident has |interested in the project. The|work is satisfactory. |The quality of the work is very|interest for the project. The | |

| |difficulties with the |quality of the work is not | |good. Demonstrates a good |quality of the work is | |

| |scientific-thought process. |always satisfactory and the | |command of the |excellent. Demonstrates an | |

| | |resident shows at times | |scientific-thought process. |excellent command of the | |

| | |difficulties with the | | |scientific-thought process. | |

| | |scientific-thought process. | | | | |

|Justify your rating using concrete examples: |

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|E. PROFESSIONAL AND INTERPERSONAL BEHAVIOURS |

|Interpersonal Team Relationships |□ |□ |□ |□ |□ |□ |

| |Behaviour interferes with the |Poor team player, behaviour |Active member of the team who |Good, active team player with |An active member of the team | |

| |working of the team; |does not facilitate the working|works well with other members, |developing leadership |whose leadership qualities are | |

| |discourteous to other members |of the team, difficulty |but whose leadership skills are|qualities. |recognized by others; able to | |

| |of the team; undermines team; |communicating with team |underdeveloped. | |achieve best results in | |

| |may be condescending, |members; may fail to take | | |difficult situations without | |

| |patronizing, passive or |appropriate responsibility for | | |antagonizing others. | |

| |aggressive. |own contribution to the team. | | | | |

|Justify your rating using concrete examples: |

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|Sense of responsibility |□ |□ |□ |□ |□ |□ |

| |Not responsible; does less than|Cannot always be depended upon;|Dependable; reliable; honest; |Takes initiative; acts |Very conscientious, | |

| |prescribed work; needs repeated|needs reminders sometimes. |prompt. |independently; always completes|consistently displays | |

| |reminders. | | |assigned tasks; reliable and |exceptional attention to duties| |

| | | | |honest. |and is prepared to give extra | |

| | | | | |time willingly. | |

|Justify your rating using concrete examples: |

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|Self-Assessment Ability (Insight) |□ |□ |□ |□ |□ |□ |

| |Unaware of own limitations; |Inconsistent awareness of own |Usually aware of own |Aware of own limitations; seeks|Well aware of own limitations; | |

| |does not seek feedback; unable |limitations; some difficulty |limitations; often seeks |feedback regularly and acts to |raises constructive questions; | |

| |to request required assistance;|seeking feedback and taking |feedback and/or assistance to |improve behaviour. |seeks feedback to excel. | |

| |unable to take advice |advice professionally. |overcome deficiencies. | | | |

| |professionally. | | | | | |

|Justify your rating using concrete examples: |

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RESIDENT’S PERSONAL LEARNING OBJECTIVES FOR THIS ROTATION

Please assess whether the resident’s personal learning objectives were met during the rotation

|ASSESSMENT OF PERFORMANCE |Unmet |Partially Met |Met |NOT OBSERVED |

|List personal learning objectives |

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MID-ROTATION ASSESSMENT OF RESIDENT

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|ASSESSMENT OF PERFORMANCE |□ |□ |□ |□ |□ |□ |

| |Requires significant guidance |Often requires guidance to |Requires some guidance to work|Requires minimal guidance to |Works independently at the | |

| |to practice at the expert |practice at the expert level. |at the expert level. A few |work at the expert level. |expert level. | |

| |level. Critical or significant|Some gaps identified that |gaps remain that require | | | |

| |gaps identified that require |require further focused |development. | | | |

| |development. |development. | | | | |

If overall performance at mid-point rated at 1 or 2, resident should develop and implement a plan to address the areas requiring improvement. Residency coordinator should be aware of and assist in development and implementation of plan, along with rotation preceptor.

Individual areas also rated as a 1 or 2 should also have an action plan developed to address and improve these specific areas.

Resident’s detailed action plan:

|Resident signature: |Date: |

|Preceptor signature: |Date: |

FINAL ROTATION ASSESSMENT OF RESIDENT

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|Evaluation Domain |Domain Average |Weighting |Sub-Total |Overall Grade: |

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| | | | |HONOURS (Average ≥ 3.0 in each domain and total ≥24/30) |

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| | | | |PASS (Average ≥ 3.0 in each |

| | | | |domain and total ................
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