2015-2016 American Association of Colleges of Pharmacy (AACP)
Master Preceptor Recognition Program (MPRP)
Direct Supervisor/Peer Colleague Assessment/Evaluation for
Master Preceptor Nominee
Master Preceptor Nominee: _____________________________________________
Evaluator Name: ______________________________________________________
Evaluator Title: ________________________________________________________
Evaluator Employer and Work Address: ___________________________________
______________________________________________________________________
Evaluator Telephone Number: ___________________________________________
Evaluator Email Address: _______________________________________________
Evaluator Relationship to Master Preceptor Nominee (Supervisor or Peer):
______________________________________________________________________
Evaluator Telephone Number: ___________________________________________
Evaluator Signature: _________________________________
Date: __________
The purpose of the American Association of Colleges of Pharmacy (AACP) Master Preceptor
Recognition Program (MPRP) is to nationally recognize preceptors who are not full-time
employees of a school/college of pharmacy for their sustained commitment to excellence in
experiential education and professional practice. Master Preceptor Nominees will be evaluated
based upon their demonstration of and contributions to Experiential Education, Pharmacy
Practice, Community Service, and Awards/Recognition. The MPRP is funded in part by the
American Pharmacists Association (APhA), the American Society of Health-System
Pharmacists (ASHP), the National Association of Boards of Pharmacy (NABP) Foundation, and
the National Association of Chain Drug Stores (NACDS) Foundation.
This instrument is being used to evaluate preceptor-specific criteria of excellence in the
education of PharmD students. To complete the assessment please select the response that
best corresponds with your level of agreement with each statement. All data will remain
confidential. You should note your responses directly on this form (either electronically or print
clearly), save as a PDF document and submit electronically to the experiential education
department of the school/college of pharmacy nominating the preceptor listed above. Note that
the response “Not Applicable” should be selected only if you have insufficient information on
which to base your evaluation of a particular item. In addition, the narrative portion of this
evaluation must be completed in order for this evaluation to be complete.
2015-2016 AACP Master Preceptor Recognition Program Assessment/Evaluation Form for
Direct Supervisor/Peer Colleague of Master Preceptor Nominee
Please use the following scale for the questions below:
1=strongly disagree; 2=disagree; 3=neutral; 4=agree; 5=strongly agree;
N/A=insufficient information to evaluate
As a practitioner/preceptor, the master preceptor nominee….
Disagree
1. Possess Leadership/Management skills by…
a. Demonstrating effective managerial and leadership
relationships with pharmacist colleagues and staff
Agree
1
2
3
4
5
N/A
b. Demonstrating aspects of humility related to
his/her own limitations
1
2
3
4
5
N/A
c. Monitoring quality of professional practice and
teaching activities
1
2
3
4
5
N/A
d. Demonstrating nondiscriminatory behavior and practice 1
2
3
4
5
N/A
e. Being active in professional organizations (e.g., ACA ,
ACCP, AMCP, APhA, ASCP, ASHP, NCPA etc.)
1
2
3
4
5
N/A
1
2
3
4
5
N/A
b. Having a mission or vision statement of pharmacy
1
2
3
4
5
N/A
c. Patterning his/her practice after standard guidelines
or other model practices
1
2
3
4
5
N/A
d. Insisting that ownership or administration supports
pharmaceutical care services
1
2
3
4
5
N/A
1
2
3
4
5
N/A
b. Ethical decision making
1
2
3
4
5
N/A
c. Patient care problem solving
1
2
3
4
5
N/A
d. Providing medication, diseases and health
education to patients
1
2
3
4
5
N/A
e. Professional patient care behavior
1
2
3
4
5
N/A
2. Embodies his/her practice philosophy by…
a. Demonstrating personal motivation and by inspiring
pharmacists to develop pharmaceutical care practice
3. Is a role model practitioner in…
a. Providing patient-centered pharmaceutical care
2015-2016 AACP Master Preceptor Recognition Program Assessment/Evaluation Form for
Direct Supervisor/Peer Colleague of Master Preceptor Nominee
Please use the following scale for the questions below:
1=strongly disagree; 2=disagree; 3=neutral; 4=agree; 5=strongly agree;
N/A=insufficient information to evaluate
As a practitioner/preceptor, the master preceptor nominee….
Disagree
Agree
4. Is an effective, organized, and enthusiastic teacher by...
a. Teaching by example
1
2
3
4
5
N/A
b. Demonstrating patient assessment skills
1
2
3
4
5
N/A
c. Demonstrating and discussing my own clinical
reasoning process
1
2
3
4
5
N/A
d. Demonstrating ethical behavior and high personal
character
1
2
3
4
5
N/A
e. Having a strong command of drug therapy knowledge
1
2
3
4
5
N/A
f. Demonstrating a caring attitude towards students and
patients
1
2
3
4
5
N/A
g. Teaching patient-provider communication skills
including empathic listening skills
1
2
3
4
5
N/A
3
4
5
N/A
5. Encourages self directed learning of the student with constructive
feedback by...
a. Identifying and responding to each student’s specific
1 2
learning needs
b. Challenging the learning process of each student
pharmacist
1
2
3
4
5
N/A
c. Coaching student pharmacist behavior through
effective, constructive and timely feedback
1
2
3
4
5
N/A
d. Making student pharmacist teaching an important focus 1
of the practice site
2
3
4
5
N/A
e. Treating students as colleagues-in-training
1
2
3
4
5
N/A
1
2
3
4
5
N/A
6. Has well developed interpersonal/communication skills
2015-2016 AACP Master Preceptor Recognition Program Assessment/Evaluation Form for
Direct Supervisor/Peer Colleague of Master Preceptor Nominee
Please use the space below to describe how the Master Preceptor nominee has demonstrated
continuous commitment and contribution to experiential education and pharmacy practice. This
description may also include expanding on the ratings provided above regarding the nominees’
leadership/management skills, pharmacy practice philosophy, ability as an effective and
enthusiastic teacher and/or encouraging the self-directed learning of students. Specific
examples of any of these attributes witnessed during your time working with the nominee may
be included. This narrative portion of this evaluation must be completed in order for this
evaluation to be considered complete.
2015-2016 AACP Master Preceptor Recognition Program Assessment/Evaluation Form for
Direct Supervisor/Peer Colleague of Master Preceptor Nominee