Rotation Structure Worksheet – APPE Community Company/Site: ______________________________________________________________________________________________________ Participant: ___________________________________ E-mail:_______________________________________ Contact #: _______________ Competency Activity (How is it achieved?) Teaching Method Assessment/Documentation Status IP/TBD Time Frame 1 Speak and write clearly, using logical patterns of organization. □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ IP □ TBD □ 1st half □ 2nd half □ Ongoing 2 Demonstrate sensitivity and tolerance within a culturally diverse society. □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ IP □ TBD □ 1st half □ 2nd half □ Ongoing 3 Demonstrate an appreciation of the obligation to participate in efforts to help individuals and to improve society and the health care system. □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ IP □ TBD □ 1st half □ 2nd half □ Ongoing 4 Promote intellectual growth and continued professional competence through self-learning. □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ IP □ TBD □ 1st half □ 2nd half □ Ongoing 5 Gather and organize information in order to identify ongoing or potential drug-related problems and the root cause of the problems. □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ IP □ TBD □ 1st half □ 2nd half □ Ongoing Status: IP – In Progress / TBD – To Be Developed Time Frame: H1 – 1st half of rotation / H2 – 2nd half of rotation / ONG – Ongoing [Type text] Page 1 6 Interview the patient/caregiver to help determine the adequacy of patient therapeutic selfmanagement. □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ IP □ TBD □ 1st half □ 2nd half □ Ongoing 7 Communicate alternative dosage strategies to the prescriber to help resolve specific patient therapeutic problems. □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ IP □ TBD □ 1st half □ 2nd half □ Ongoing 8 Monitor the safety and efficacy of therapeutic plans. □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ IP □ TBD □ 1st half □ 2nd half □ Ongoing 9 Receive and correctly interpret oral and written prescription orders. □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ IP □ TBD □ 1st half □ 2nd half □ Ongoing 10 Verify prescription order for legitimacy and apply local, state, and federal regulations properly when filling prescriptions. □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ IP □ TBD □ 1st half □ 2nd half □ Ongoing 11 Collaborate with physicians, other health care professionals, patients, and/or their caregivers to formulate a pharmaceutical care plan. □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ IP □ TBD □ 1st half □ 2nd half □ Ongoing 12 Integrate basic knowledge as needed to design, implement, and evaluate patient-specific pharmacotherapeutic regimens. □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ IP □ TBD □ 1st half □ 2nd half □ Ongoing Status: IP – In Progress / TBD – To Be Developed Time Frame: H1 – 1st half of rotation / H2 – 2nd half of rotation / ONG – Ongoing [Type text] Page 2 13 Identify allergies and potential drug-drug and drug-disease interaction when using the patient’s drug profile. □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ IP □ TBD □ 1st half □ 2nd half □ Ongoing Integrate patient and drug information with drug dosing 14 methods to calculate appropriate dosage adjustments. □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ IP □ TBD □ 1st half □ 2nd half □ Ongoing 15 Accurately prepare prescriptions. □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ IP □ TBD □ 1st half □ 2nd half □ Ongoing 16 Counsel patients/caregivers on OTC medications and devices. The student is required to counsel two patients using the patient consultation form – see appendix □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ IP □ TBD □ 1st half □ 2nd half □ Ongoing 17 Counsel patients/caregivers on prescription medications. The student is required to counsel two patients using the patient consultation form – see appendix □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ IP □ TBD □ 1st half □ 2nd half □ Ongoing 18 Display the attitudes, habits, and values required to render pharmaceutical care. □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ IP □ TBD □ 1st half □ 2nd half □ Ongoing 19 Demonstrates understanding of purchasing, inventory management, and storage of controlled substances. □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ IP □ TBD □ 1st half □ 2nd half □ Ongoing Status: IP – In Progress / TBD – To Be Developed Time Frame: H1 – 1st half of rotation / H2 – 2nd half of rotation / ONG – Ongoing [Type text] Page 3 20 Demonstrates knowledge of purchasing, inventory management, and storage of prescription and non-prescription medications. □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ IP □ TBD □ 1st half □ 2nd half □ Ongoing 21 Demonstrates understanding of third-party payers and formulary procedures. □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ IP □ TBD □ 1st half □ 2nd half □ Ongoing □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ IP □ TBD □ 1st half □ 2nd half □ Ongoing 23 Identify and use appropriate drug information resources to respond to patient specific drug problems or inquiries from other health professionals. □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ IP □ TBD □ 1st half □ 2nd half □ Ongoing 24 Develop and present educational materials tailored to the needs and educational background of a given audience (e.g. staff presentations, journal clubs, etc.). 25 Demonstrate judgment, initiative, responsibility, and maturity. Displays a cooperative attitude and is receptive to feedback. □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ IP □ TBD □ 1st half □ 2nd half □ Ongoing □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ IP □ TBD □ 1st half □ 2nd half □ Ongoing 26 Responds to assignments and responsibilities in a timely manner. □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ IP □ TBD □ 1st half □ 2nd half □ Ongoing 22 Comply with federal, state, and local laws and related regulations that affect the practice of pharmacy. Status: IP – In Progress / TBD – To Be Developed Time Frame: H1 – 1st half of rotation / H2 – 2nd half of rotation / ONG – Ongoing [Type text] Page 4 27 Reports to rotation site, patient care activities, group discussions, and meetings on time. □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ IP □ TBD □ 1st half □ 2nd half □ Ongoing 28 Exhibits neatness and professionalism in appearance and work. □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ IP □ TBD □ 1st half □ 2nd half □ Ongoing 29 Maintains confidentiality. □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ IP □ TBD □ 1st half □ 2nd half □ Ongoing 30 Demonstrates tact when dealing with staff, patients, and other health professionals. □ Lecture □ Panel experts □ Video Tapes □ Small Group □ Case Studies □ Guest Speaker □ Project □ Role Play □ Observation □ Group Discussion □ Guided Practical Experience □ Other: __________________________________ □ Test □ Quiz □ Resrch. Paper □ Indiv. .Project □ Group Project □ Poster □ Oral Presentation □ Hmwrk □ Lab exe. □ Demonstration □ Case □ Other □ Observation □ Documentation__________________________ □ IP □ TBD □ 1st half □ 2nd half □ Ongoing Status: IP – In Progress / TBD – To Be Developed Time Frame: H1 – 1st half of rotation / H2 – 2nd half of rotation / ONG – Ongoing [Type text] Page 5