IPPE-3 Preceptor Assessment of Student-Midpoint
Student Name:
Site:
Preceptor Name:
Start date:
End date:
IPPE Professionalism Competencies
Rating details
2 = Meets expectations of a student at this level.
1 = Student does not meet expectations of a student at this level.
Once the rating is selected, use the comment section to provide further insight regarding the student’s performance.
Comments are REQUIRED following any score of one (1), to provide specific examples of areas needing improvement.
Professionalism Competencies
2. Meets Expectations
1. Does Not Meet Expectations
1.
Student communicates articulately, i.e., clearly communicates thoughts;
uses appropriate terminology and vocabulary for intended audience.
1
2
2.
Student maintains confidentiality, i.e., engages in discussions or other
activities involving patient- and/or site-specific information for purposes of
fulfilling professional responsibilities only; maintains confidential nature of
patient- and/or site-specific documents.
1
2
Student demonstrates accountability, i.e., holds oneself liable for
tasks/duties/responsibilities that he/she is responsible; does not blame
others for mistakes or mishaps, nor avoids responsibilities.
1
2
4.
Student accepts and applies constructive criticism, i.e., responds openly
and positively to feedback; modifies behavior if necessary.
1
2
5.
Student is respectful, i.e., demonstrates regard for patients, superiors,
colleagues, other personnel, and property; acts in a manner that shows
recognition that he/she is a guest at the practice site as a professional
student.
1
2
6.
Student demonstrates confidence, i.e., acts and communicates in a selfassured manner, yet with modesty and humility.
1
2
7.
Student is empathetic, i.e., demonstrates appreciation of others’ positions;
attempts to identify with others’ perspectives; demonstrates consideration
towards others.
1
2
Student behaves in an ethical manner, i.e., acts in patients’ best interests;
acts in accord with the profession’s and/or practice site’s code of ethics.
1
2
3.
8.
9.
Student is punctual, i.e., arrives at practice site and meetings early or on
time; meets deadlines for completion of tasks and responsibilities.
1
2
10. Student wears appropriate attire, i.e., adheres to dress code (written or
unwritten); attire is acceptable to practice setting.
1
2
Additional Professionalism Comments:
IPPE Intern Competencies
Rating details
4 = Performs within and often beyond the expectations of a student at this level.
3 = Performs within the expectations of a student at this level in most areas.
Some areas are still in need of growth.
2 = Performs within the expectations of a student at this level in only some areas.
Several areas are still in need of significant growth.
1 = Student has too many areas needing development.
N/A = Not addressed
Once the rating is selected, use the comment section to provide further insight
regarding the student’s performance. Comments are REQUIRED following any score
of two (2) or one (1), to provide specific examples of areas needing improvement.
1.
1. Accurately dispense medications or order fulfillment (patient safety
element)
Ability Statement: Demonstrate a commitment to and a valuing of patient safety
by assuring accurate preparation, labeling, dispensing and distribution of
prescriptions and medication orders. Select the appropriate medication,
compounding (sterile and non-sterile), reconstitution of medications, sterile
product preparation, administration of vaccines, reading prescriptions, using
abbreviation, utilize computer systems.
N/A 1 2 3 4
2. Basic Patient Assessment
Ability Statement: Collect, record, and assess subjective and objective patient
data to define health and medication-related problems. Patient information
must be collected in a manner demonstrating knowledge of patient educational
level, the unique cultural and socioeconomic situations of patients, and comply
with requirements for patient privacy. Obtain demographic information,
medication history, allergies.
N/A 1 2 3 4
3. Medication Information
Ability Statement: Demonstrate knowledge of and accept responsibility for that
knowledge of commonly used medications, formulations and drug products.
Respond to drug information questions, assist in medication error and adverse
drug identification, observe medication therapy management, become familiar
with available resources.
N/A 1 2 3 4
4. Identification and Assessment of Drug related Problems
Ability Statement: Correlate drug related variables and patient related variables
to identify and assess drug related problems. Evaluate how the unique
characteristics of patients and patient populations impact on manifestations of
drug-related problems. Participate in medication reconciliation, observe MTM.
5.
N/A 1 2 3 4
Mathematics applied to pharmaceutical calculations, compounded
medications, dose calculations, and applications of pharmacokinetic
calculations
Ability Statement: Utilize pharmaceutical and pharmacokinetics mathematics to
perform accurate medication calculations. Value the importance of total
accuracy in performing and applying these calculations. Reconstitution of
medications, compounding, dose calculations, dose verifications.
N/A 1 2 3 4
6. Ethical, Professional, and Legal Behavior
Ability Statement: In all health-care activities, demonstrate knowledge of and
sensitivity towards the unique characteristics of each patient. Comply with all
federal, state, and local laws related to pharmacy practice. Demonstrate ethical
and professional behavior in all practice activities. Emergency supplies, record
keeping, controlled substance issues.
N/A 1 2 3 4
7. General Communication Abilities
Ability Statement: Demonstrate effective communication abilities in interactions
with patients, their families and care givers, and other health care providers.
Communication should be consistent with education level, cultural issues, and be
empathetic. Elicit feedback validating understanding of communication.
N/A 1 2 3 4
8. Patient Interaction and Education
Ability Statement: Provide effective health and medication information to
patients and/or care givers and confirm patient and/or care giver understanding
of the information being provided. Patient counseling.
N/A 1 2 3 4
9. Drug Information Analysis and Literature Research
Ability Statement: Assess information needs of patients and health providers and
apply knowledge of study design and literature analysis and retrieval to provide
accurate, evidence-based drug information.
10.
Health and Wellness – Public Health
Ability Statement: Know and apply principles of health and wellness in the
provision of individual and population-based health and wellness information.
Integrate unique characteristics of individuals and populations in the design of
health and wellness information.
11.
N/A 1 2 3 4
N/A 1 2 3 4
Insurance /Prescription Drug Coverage
Ability Statement: Utilizing knowledge of a wide array of private and public
health insurance options assist patients and care givers to obtain their
medications and related para-pharmaceuticals in an affordable manner that
meets their health care needs. Observe prior authorization process, learn about
formulary process.
N/A 1 2 3 4
12.
Interprofessional Health Care Team
Ability Statement: Understand the roles and responsibilities of and interact
appropriately with all members of the health care team. Obtain refill
authorization for an existing prescription, clarification of a new prescription.
13.
N/A 1 2 3 4
Medication Use Systems
Ability Statement: Understand the various medication use systems across
practices of pharmacy.
N/A 1 2 3 4
Additional Intern Competency Comments:
My global assessment is the student performs at a reasonable level of proficiency based on their current
progression in their pharmacy training.
Agree
or
Disagree
By signing below you agree the student has completed all required hours for this section of the
course, and that this assessment has been reviewed and discussed with the student.
Preceptor Signature
Student Signature
Date
Date