Self-Assessment
HOSPITAL
PGY-1 Residency
CITY, STATE
Resident’s Name
Resident’s Signature ____________________________________________
Date ______________________
Program Directors Signature _____________________________________
Date ______________________
1)
Please review the following WBH (CITY) PGY-1 residency program goals. For each goal, provide a selfassessment of your current practice level. Identify any program goals that you would like to emphasize,
either because of interest or perceived need for improvement.
Be sure to rate every goal.
Ratings:
1 = Minimal exposure/experience, need opportunity for additional training to achieve
2 = Some exposure/experience; additional experience beneficial
3 = Good baseline exposure/experience; additional experience beneficial
4 = Significant baseline experience; feel confident that goal will be easily achieved
5 = Significant baseline experience; feel confident that goal has been achieved prior to residency
Program Goal
Baseline
Rating
Rationale For Your Rating
End of
Residency
Rating
Manage & Improve Medication Use Process (Outcome)
(R1.1) Identify opportunities for improvement
in organization's medication use system
(R1.2) Design & implement quality
improvement changes to the organization's
medication use system
(R1.3) Prepare and dispense medications
following existing standards of practice and
the organization’s policies and procedures
(R1.4) Demonstrate ownership of and
responsibility for the welfare of the patient by
performing all necessary aspects of the
medication-use system
Provide evidence-based, patient –centered medication therapy management with interdisciplinary teams
(Outcome)
(R2.1) As appropriate, establish collaborative
professional relationships with members of
the health care team
(R2.2) Place practice priority on the delivery
of patient-centered care to patients
(R2.3) As appropriate, establish collaborative
professional pharmacist-patient relationships
(R2.4) Collect and analyze patient
information
(R2.5) When necessary, make and follow up
on patient referrals
(R2.6) Design evidence-based therapeutic
regimens
Program Goal
Baseline
Rating
Rationale For Your Rating
End of
Residency
Rating
Provide evidence-based, patient –centered medication therapy management with interdisciplinary teams
(Outcome) - continued
(R2.7) Design evidence-based monitoring
plans
(R2.8) Recommend or communicate
regimens and monitoring plans
(R2.9) Implement regimens and monitoring
plans
(R2.10) Evaluate patients’ progress and
redesign regimens and monitoring plans
(R2.11) Communicate ongoing patient
information
(R2.12) Document direct patient care
activities appropriately
Exercise leadership and practice and practice management skills (Outcome)
(R3.1) Exhibit essential personal skills of a
practice leader
(R3.2) Contribute to departmental leadership
and management activities
(R3.3) Exercise practice leadership
Demonstrate project management skills (Outcome)
(R4.1) Conduct practice-related
investigations using effective project
management skills
Provide medication and practice-related education/training (Outcome)
(R5.1) Provide effective medication and
practice-related education, training, or
counseling to patients, caregivers, health care
professionals, and the public
Utilize medical informatics (Outcome)
(R6.1) Use information technology to make
decisions and reduce error.
Conduct pharmacy practice research (Outcome)
(E1.1) Design, execute and report results of
investigations of pharmacy practice related
issues
Program Goal
Baseline
Rating
Rationale For Your Rating
End of
Residency
Rating
Contribute to formulary decisions (Outcome)
(E6.1) Participate in the organization’s
formulary process
Provide drug information to health care professionals and/or the public (Outcome)
(E7.1) Identify a core library, including
electronic media, appropriate for a specific
practice setting
(E7.3) Provide concise, applicable,
comprehensive, and timely responses to
requests for drug information from patients,
health care providers, and the public
2)
What are your strengths? This should include direct patient care skill as well as personal strengths.
3)
Reflect upon the following 2 items: 1) the professional skills and attitudes you believe are most
characteristic of a successful pharmacist and 2) areas you wish to improve upon during the residency year.
From this reflective exercise identify 4 goals you have for self improvement during your residency year
Baseline:
End of Residency:
Rank in Order of
Self Improvement Goals
Importance
Achieved? Rank in Order of
(1=most
(Y/N)
Importance
important)
Personal goal:
Personal goal:
Personal goal:
Personal goal:
4)
What is your personal strategy for life-long pharmacy continuing education?
5)
Describe the type of position that you hope to assume following the residency program. Include the
therapeutic area, practice setting, involvement in practice/teaching/research, etc.
6)
List professional organizations of which you are a current member. Have you had any active involvement
such as serving on a committee?
7) Please complete the following table, listing each past clerkship experience and length of each experience.
Weeks
Rotation
Comments
Completed
8.
Required Learning Experiences
The required PGY-1 learning experiences at Beaumont are:

Orientation

Ambulatory

Internal Medicine

Drug Information

Critical Care

Practice Management

Integrated Practice Experience
The Integrated Practice Experience (IPE)
Concentrated Experience Options
Integrated Practice Experience
Internal Medicine*
Medicine
Pain Management
Medicine
Transplant
Medicine
CICU**
Medical Progressive Care
SICU (CV)**
Medical Progressive Care
MICU**
Medical Progressive Care
Internal Medicine*
Medical Progressive Care
CICU**
Cardiology
*meets Internal Medicine rotation requirement for program
**meets ICU rotation requirement for program
Please identify a first and second choice option for completion of your concentrated experience/IPE.
First Choice:
Second Choice:
Please state if you would like your concentrated experience to meet a rotation requirement (if
applicable).
Elective Learning Experiences:
Each resident will have either 4 or 5 elective learning experiences during their residency year. If the
concentrated experience selected fulfills either an Internal Medicine or ICU learning experience requirement,
then you will have five one-month elective rotations. If the concentrated experience selected does not meet
an IM or ICU requirement, you will have 4 one-month elective rotations.
If desired, required rotations (i.e. internal medicine, ambulatory, critical care) may additionally be chosen as
an elective experience once (max 2 learning experiences in one area).
Please identify your preferred elective learning experiences:
Elective Experience
Internal Medicine
Oncology
Ambulatory
Drug Information
Cardiac ICU
You will have a minimum of 4 elective rotations. This may
go to 5 depending upon your IPE choice.
Please rank your top choices with 1 being your first
choice. Please rank order 2 more learning experiences
than you need. For example if you need 4 rank six
rotations 1-6, if you need 5 rank seven rotations 1-7
Surgical ICU
Medical ICU
Nutritional Support
Investigational Drugs
Emergency Medicine
Infectious Disease
Medication Safety
Academics
PICU
Informatics
OR Pharmacy Services
Anticoagulation Management
(Non Patient Care)
Transplant
Please list any rotations that you would specifically like before the December ASHP Midyear Clinical Meeting:
Please list any other schedule/training plan desires concerns
ACLS training may be available. Completion is optional. Is this a course you would be interested in
completing?