Informational Services (PHPC 577) PreceptorEvaluationof Student2008- 2009

StudentName:
PreceptorName:
Rotation Site: Start Date:
Total Score: I r20 Pleaseadd up each of the points boxes)
Pleaseconsider all of the drug i estions and responsessubmitted by the sfudent when assessingthe sfudent's
InformationalServiceactivities. Pleasecircle the appropriateAssessment
box (e.g.,Outstanding,Acceptable,or Not
acceptable)and corresponding pointswhereindicatedon this evaluationform. The maximumnumberof pointspossibleis
120.
The studentandpreceptorsigt this form to attestthat the courseobjectives,includingthe requiredhoursof participation,were
accomplishedandthat the assessment was discussed.This doesnot necessarilyindicatethe student'sagreementwith the
assessment.

'erminal
rminal Skill
Skill Il: Receive a drag information query in a comDrehensive fashion.
Item: 1: Bockgroand Questions
Rating Points Performance Criteria Comments:

As in Acceptable AND ba&ground questioru demonstate student's ability to synthesizedata to be able

to identi$ additional appropriatequestionsto ask ofthe requestorand allow the studentto determine
Outstanding l0 "why" the requestoris asking for the information (i.e., dononstrates the student can construct a broad
view ofpossible issuessurroundingthe case)AND studentshowsefficiencyby limiting collection of
exftaneousinformation
The student obtains appropriate equestor demogra,phics(e.g., profession), AND asksbackground
Acceotable
't f questionsappropriate for the original query AND the backgroundquestionshelp the student identifu the
true need ofthe requestor (i.e., determining the true question)
Not Does not meet all criteria for Acceptable as stated above
0
acceptable

Item 2: Formulation of Database

Points Performance Criteria Comments:
Databaseofinformation collected by the studentis comprehensiveand complete- information collected ey\\W
Outstanding
allows studentto anticipateadditionalquestionsthe requestormay ask after the orieinal qu flln<-'.
Databaseofinformation collectedby the studentcontainsadequateandrelevantinformation to
Acceptable
accuratelvaddressthe drue informationqu 1-li *''- te
Pertinentinformation for the databaseis frequentlymissing i',' inu\ t
l'l
{-E J.h {,"t1 l,

Item 3: Formulotion ond Categorization of Question

Points Performance Criteria Comments:

As in Acceptable AND studentis able to clariS the actualDI need by formulating a focused,specific
Outstanding

Student correctly categorizesthe ultimate question after assessingthe background information collected
Does not meet all criteria for Acceptable as stated above

PreceptorComments:(notestrengths,weaknesses,
or any information of value to the studentregardingthe aboveitems
in Skitt 1)
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PHPC577 lnformationalServices
@ 2008Universityof MarylandSchoolof Pharmacy.All rightsreserved.
 'erminal Skill 2: Analvze and research a drug informttion question thoroushl
ftem 4: Knowledge of Drug Information Resources
Rating Points Performance Criteria Comments:
As in Acceptable AND the studentdemonstates knowledge of and familiarity with gold standardreferences
Outstanding l0 for specificquestiontypes(e.g.,Briggs' for pregnancyand lactationquestions;Trissel's for compatibility
questions)
Student demonsftatesadequateknowledge ofdrug information r€soulces;demonstratesgeneralknowledge
Acceptablef of advantages.anddisadvantagesof ditrerent types of literature (i.e., primary, secondary,tertiary) and
\ standardresources- in other words, resourceschosenare appropriatefor the DI need
Not Does not meet all criteria for Acceptable as stated above
0
acceptable

Item 5: Search Strategv

Rating Points Performance Criteria Comments:
As in AcceptableAND nreetsat leastONE of the following criteria:(1) studentdemonstatesability to
develop an effcient searchstrategy,minimizing the use of extraneousor unnecessaryresources(e.g., the
Outstanding l0 student does NOT perform a Medline searchfor questionsthat can be answeredwith the use of standard
tertiary references);(2) for secondaryliterature searches,studentnotes specific databasesand searchterms
used
' )1
Student's searchstrategiesappearappropriate for various question types AND information resourceschosen
Acceptable

Not
v by student appearsufficient for the query AND if secondaryliterature (e.g., Medline) searchesare
performed, studentsare able tc identify relevant citations
Does not meet all criteria for Acceptable as stated above
0
acceptable

Item 6: Evaluation ond Analvsis of Collected Information

Rating Points Performance Criteria Comments:

/\ As in Acceptable AND meets at least ONE of the following criteria: 1) studentidentifies clinically relevant
limitations to data (may include gaps in known knowledge on a topic);2) for primary literature, student
Outstanding r0 i
determineswhether conclusionsoftrials are supportedby study methodology and results; 3) ifpresent for
*/ the topic, studentcorrectly identifies areasofcontoversy in the topic
Student demonstratesan ability to identiS key information in selectedsources/ reports (i.e., able to extract
relevantdata) AND identifieslimitationsto variousdataresourcesanddifferentstudytypes(e.g.,
Acceptable 8
randomizedcontrolled trial vs. caseseries),AND when relevant, student demorstratesan ability to assess
the methodology of primary studies ard the potential for bias and/or limitations presentin clinical tials
Not Doesnot meetall criteria for Acceptableas statedabove
0
acceptable

PreceptorComments:(note strengths,weaknesses,
or any information of value to the studentregardingthe aboveitems
for Skill2)

Tenninal Skill 3: Resoondsaooronriatelv to a drus informdion querv related to natient care

Item 7: Assimilation of Data and Drug Information Responses
Rating Points Performance Criteria Comments:

As in Acceptable AND whenrelevant to the reques! responsesaddres potential anticipaory questions

of the requestor(e.g., for a drug interaction question,the responsenot only tells the requestorabout the
Outstanding l0
interaction [i.e., mechanism,severity], but also includes mefiods of management,monitoring parameters,
and/or treatment albrnatives when appropriate)
/'l r Student demonstratesan ability to assimilate data from multiple sourcesto develop focued, cohesive
f ) I
Acceptable is1 responsesAND responsesaccurately and completely addess the original DI query considering specific
patient characteristicswhen relevant
Not Doesnot meetall criteria for Acceptableas statedabove
0
acceptable

PHPC 577 InformationalServices

@ 2008Universityof MarylandSchoolof Pharmacy.All rightsreserved.
Item 8: Judsments ond Recommendations
Performance Criteria Comments:
As in Acceptable AND meets at least ONE of the following criteria: (l) the student is able to develop an
Outstanding appropriate recommendationwhen there is limited and/or conflicting data; (2) the student's clinical YI&/
decisions/ recommendationsdemonstrateinsieht and critical thinkine skills

Acceptable
Responsesdemonstate student's ability to apply data to individual patients / questions,making appropriate
recommendationsbased on the available data,the limitations of the data, and the patbnt specific
ty
characteristics when apDroDriate .T
Does not meet all criteria for Acceptable as stated above Ytitul

Item 9: Communicotion of Response

Rating Points Performance Criteria Comments:

/; As in Acceptable AND responsesare well-organized and concisely written and do not include urmecessary
Outstandiner t9/
-L or unorqanized exfraneousdata that may obscureand/or confuse the primary messagesto the requestor
Responsesare appropriate for the level ofthe requesbr AND responsesare clearly written and use
Acceptable 8
appropriate gralnmar
Not Does not meet all criteria for Acceptable as stated above
0
acceptable

Item 10: Provides Appropriate References

Rating Points Performance Criteria Comments:

As in Acceptable AND referencesare provided in a consistentand standardcitation format (e.g., Uniform

\ l0
Outstandind
Requirements,AMA, AJHP, etc) that would albw others to find the information readily
All factual information is appropriately referencedAND number and type of referencesappearappropriate
Acceptable 8
basedon question(e.g.,informationis confirmedin multiple sourceswhenappropriate)
Not Doesnot meetall criteria for Acceptableas statedabove
0
acceptable

Item I I: Response Integritv

Rating Points Performance Criteria Comments:

Information provided by ihe student is appropriately paraphrasedand referenced. lnformation is NOT a

Acceptablt' l0 i
t
replication (i.e.,cut andpaste)ofother publishedsources
Not Doesnot meetall criteria for Acceptableas statedabove
0
acceptable

Item 12: Complexity and Variety of Questions

Rating Points Performance Criteria Comments:

On a consistentbasis (>85% of the time), the questionsand responses$bmitted by the student arc an
Acceptable

Not
!, appropriatemix of complexity- i.e., the l0 questionscontain a good mixof simple,moderate,and
cornplex questions
Does not meet all criteria for Acceptable as statedabove(e,g., studentsubmits a disproportionate
0
acceptable nurnber of simple questions)
or any information of value to the studentregardingthe aboveitems
PreceptorComments:(note strengths,weaknesses,
for Skitl3)

PHPC 577 InformationalServices

@ 2008 University of Maryland Schoolof Pharmacy.All rights resenred.
Professionalism and Behavior:
To be completedby preceptorat mid-point of studentrotationand at end of studentrotation. Students
must receiveall "Acceptable"marksin the following four elementsto passthe rotation. Thesecriteriado
not counttowardthe evaluationpoints for a grade.

Midpoint Final
Item 1: Patient & Provider Communications
'tr
ri

The studentconsistently(greaterthan 90%): (1) Introduces Comments:

self at first encounters;(2) Greetspatientsand otherhealth
careprofessionalswith a smile and/orpositiveinflection in
voice; (3) Guardspatientinformationfrom disclosureand
seekspermissionto discloseinformationto otherparties
Acc (e.9.family, otherhealth careprofessionals); (4)
Demonstrateseffectivelisteningskills (good eyecontact,
non-verbalcues);AND (5) Speakseffectivelyand
respectfully(e.g.not condescendirg,sarcastic,meek,nor
overly-assertive).
(l) Doesnot meetcriteriafor acceptableas statedabove;
OR (2) The studentinappropriatelydisclosedpatient
Not acceptable informationon morethan 1 occasion;OR (3) The student
madenegativeor inappropriatepublic remarksabout
colleaguesor patientson morethan I occasion.

Midpoint Final
Item 2: Appearance, Affire
rt
fr ti+
The studentconsistently(greaterthan 90%):(1) Wears Comments:
clothing that is professionalin appearance (e.g. appropriate
to the cultureof the institutionas definedby the preceptor,
Acceptable site dresscode,andprofessionalnorms);(2) Minimizes
wearingofjewelry in patientcareareas;(3) Is well-
groomed;AND (a) Wearsnamebadge.
Not acceptable Does not meet criteria for acceptable as stated above.

PHPC 577 InformationalServtces 10

@ 2008 University of Maryland Schoolof Pharmacy.All rights reserved.
 Midpoint Final
Item 3: Timeliness,Commitment
&- p
The studentcqnsi$tently(greaterthan 90%): (l) Completes Comments:
assignmentson or before deadline;(2) Arrives on time;
(3) Calls/notifiespreceptorwhen unableto meet deadlineor
$cceptable arrive on time; (4) Gives high priority to completingcourse
requirementsduring allottedrotation hours; AND (5)
Arrives preparedwith equipmentand assignmentsas
directed.
(1) Doesnot meet criteria for acceptableas statedabove;
OR (2) The studentcompletessomeresponsibilitiesin such
Not acceptable an untimely mannerthat it jeopardizespatienthealth or
institutional effi ciency.

Midpoint Final
Item 4: Initiative
L N
The studentconsistentlv(greaterthan 90%):(l) Accepts Comfrents:
responsibility and demonstratesaccountability without
repeatedreminders;(2) Demonstratesa senseof duty; (3)
Demonstratesan earnestdesireto learn; (4) Demonstrates
Acceptable
the willingness and flexibility to contributeto the
well-being of others;AND-(S) Applies knowledge,
experiorce,and skills to the best of his/trerability.
Not acceptable Doesnot meet criteria for acceptableas statedabove.

PRECEPTOR
COMMENTS:
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STI.JDENT -_fuX",l
COMMENTS:

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s SignatureI Date
YlnTou*Student'sSignatureI Date
*The preceptorand studentsign this form to attestthat the courseobjectives,including the
requiredhours of participation,were accomplishedand that the assessment was discussed.This
doesnot necessarilyindicate the student'sagreementwith the assessment.

PHPC 577 krformational Services il

@ 2008 University of Maryland Schoolof Pharmacy. All rights reserved.