Institution: Manchester University

Student: xxx
Preceptor: Jason Isch
Site: St Joseph Regional Medical Center Family Medicine Center
Date: (R06) September 25 - October 20, 2023 (09/25/23 - 10/20/23)
Type: PHRM 630 APPE Ambulatory Care (Family Medicine (DPC))

APPE DPC Evaluation (Midpoint & Final)

General overview

This document and its contents are protected by the Family Educational Rights and Privacy Act (FERPA), which
prohibits the disclosure of students’ educational information to individuals who do not have a legitimate educational
purpose in receiving such information. This form and its contents shall not be disclosed to any person or entity other
than the student or the Office of Experiential Education of Manchester University Pharmacy program.

How to apply scoring

For Section 1 (Patient Care Provider Domain – Self-Developer Domain):

Exceeds Expectations: Ready for supervision at a distance. I trust the learner to completely and accurately….

Meets Expectations: Ready for reactive supervision. I trust the learner, with limited correction, to….

Below Expectations: Ready for direct, proactive supervision. I trust the learner, with direct supervision and
frequent correction, to….

Fail: I do not trust the learner to…

Section Weight: 0%

Patient Care Provider Domain MIDPOINT FINAL

Collect information to identify a patient’s Meets – Student is efficient and Meets – Student is efficient and
medication-related problems and health-related thorough in patient work-ups. collects information
needs. She is able to appropriately appropriately. She is familiar
identify medication concerns with the common ambulatory
for disease states with which care disease states.
Question Comments Question Comments she is familiar.
(Midpoint): (Final):

Identify medication related problems. Meets Meets – Student is able to

assess for drug interactions,
renal dose adjustments, and
Question Comments Question Comments other lab parameters that
(Midpoint): (Final): restrict use (for example, when
evaluating IV antibiotic
patients)

Compile a prioritized health-related problem list Meets – Student is able to Meets – see midpoint
for a patient. identify most pertinent comments
concerns for a patient. She is
able to focus on the disease
Question Comments Question Comments state at hand without
(Midpoint): (Final): overlooking comorbidities.
Evaluate an existing drug therapy regimen for Meets – When there is a goal in Meets – Student has increased
its effectiveness. mind, Student appropriately familiarity with parameters
identifies patients that used to measure efficacy of
are/aren’t meeting treatment regimens for hypertension,
Question Comments Question Comments goals. diabetes, and heart failure, in
(Midpoint): (Final): particular.

Develop an evidence-based treatment plan for Below – Student is currently
a patient. able to identify first-line
treatment options and is now
growing in her ability to
Question Comments Question Comments evaluate literature and
(Midpoint): (Final): guidelines for more complex
patients.
Meets – In Student’s final
patient case presentation, she
demonstrated her ability to
evaluate literature and apply it
practically to a patient.

Collaborate with the patient, caregiver(s) and Below – This is an area Student Meets – Student selects
other health professionals to establish patient- has already shown appropriate treatment goals
centered goals. improvement in and will only when evaluating the patient in
continue to grow. We are entirety.
working on individualizing
Question Comments Question Comments therapy goals and blending
(Midpoint): (Final): pharmacist and provider
perspective to set those goals.

Implement a treatment plan in collaboration with Meets – Student is Meets – see midpoint
other health professionals. appropriately able to describe comments
and document the treatment
plan for understanding by both
Question Comments Question Comments the patient and other team
(Midpoint): (Final): members.

Educate a patient and caregiver(s) in the
implementation of their treatment plan.
(Examples – medications, devices, etc.)
Question Comments Question Comments
(Midpoint): (Final):
Below – As Student continues Meets – Student has gained
to gain familiarity with the familiarity in different devices
medications and devices used for diabetes and is able to
commonly used in ambulatory demonstrate use to patients.
care, she will undoubtedly meet
this goal. We will set aside time
to address this directly in the
next 2 weeks.

Assess patient adherence to the treatment plan Meets – Student excels at Meets – see midpoint
and assist with behavior change as needed. finding ways to improve patient comments
adherence, such as
recommending combination
Question Comments Question Comments tablets to reduce pill burden.
(Midpoint): (Final):

Recommend modifications or adjustments to an Meets – I don’t believe this has Meets – Student appropriately
existing medication therapy regimen based on come up directly so far, but identified alternative agents for
patient response. Student is able to identify side patients not wanting injectable
effects or concerns that would therapy.
prevent use of an agent or
Question Comments Question Comments warrant a change in therapy.
(Midpoint): (Final):
Assist in a patient’s transition to different
level(s) of care or care setting(s). (Example -
admission or discharge from a hospital or
nursing facility or transfer to a different level of
care within the same facility)
Question Comments Question Comments
(Midpoint): (Final):
Interprofessional Team
Member Domain
Collaborate as the medication expert as part of
an interprofessional team.
Question Comments Question Comments
(Midpoint): (Final):
Population Health Promoter
Domain
Review and document adverse drug events and N/A
medication errors within a medication use
system.
Question Comments Question Comments
(Midpoint): (Final):
Determine CDC-recommended immunizations
for a specific patient, then administer and
document as applicable.
Question Comments Question Comments
(Midpoint): (Final):
Information Master Domain
Educate professional colleagues or lay
audience(s) based on the evaluation of
scientific literature and its application.
Question Comments Question Comments
(Midpoint): (Final):
Use setting appropriate verbal communication
N/A – We will plan to do some Meets – Student was able to
transitions of care the next 2 evaluate a patient’s discharge
weeks to assess this. medications for optimal therapy
and identify patient counseling
points for a transitions of care
phone call.
Section Weight: 0%
MIDPOINT FINAL
Below – Specifically related to Meets – Student has progressed
ambulatory care topics, Student tremendously with creating
is not yet at the “expert” level. treatment plans based on
We will continue to focus on clinical guidelines. There is still
guideline reviews and clinical room for development, but her
decision-making to accomplish improvement is exciting!
this goal.
Section Weight: 0%
MIDPOINT FINAL
N/A
Meets – Student is able to work Meets – see midpoint
up a patient for annual wellness comments
checks, which include
vaccination recommendations.
She is also able to discuss these
recommendations with patients
effectively.
Section Weight: 0%
MIDPOINT FINAL
N/A – to be assessed after Meets – Student appropriately
patient case presentation assessed literature and applied
it to her patient case. She can
continue to work on her
presentation skills and teaching
with intent instead of as an
assignment.
Meets – Student is professional Meets
skills. yet maintains personality in her
interactions with patients and
preceptors.
Question Comments Question Comments
(Midpoint): (Final):

Use setting appropriate written communication Exceeds – Student is clear, Meets – see midpoint
skills. concise, and direct in her comments
documentation and written
communication. She requires
Question Comments Question Comments little correction in this area.
(Midpoint): (Final):

Retrieve and analyze scientific literature to N/A – will assess after patient Meets – Student appropriately
make a patient-specific recommendation and/or case presentation and thoroughly assessed 2 well-
answer a drug information question. selected trials to evaluate and
apply (successfully) to a patient
case.
Question Comments Question Comments
(Midpoint): (Final):

Section Weight: 0%

Practice Manager Domain MIDPOINT FINAL

Appropriately use common automated systems N/A N/A
to fulfill a medication order. (Example –
Automated dispensing cabinets, sterile
compounding systems, pill counting equipment)

Question Comments Question Comments

(Midpoint): (Final):

Section Weight: 0%

Self-Developer Domain MIDPOINT FINAL

Perform a self-evaluation to identify
professional strengths and weaknesses.
Question Comments Question Comments
(Midpoint): (Final):
Meets – Student is able to
identify her areas of strength
and growth appropriately.
Meets – Student was able to
identify her challenges with
presenting and her deficits in
guideline preparation. She was
also able to identify her
strengths of efficiency and
personability in interactions.

Section Weight: 0%

Professionalism and Work

Ethic
Grading Scale: Consistently, Inconsistently,
Never MIDPOINT FINAL
Appearance exemplifies that of a professional Meets Meets
(i.e. dress, hygiene).
Question Comments Question Comments
(Midpoint): (Final):

The student is self-motivated and eager to Exceeds – Student has a great
learn. attitude and is always willing to
jump in to help or lead. It is
clear she is eager to soak up
Question Comments Question Comments information and gain
(Midpoint): (Final): experience.
Exceeds – Student’s level of
learning in these past 2 weeks is
substantial and she appears
motivated to continue growing.
She has worked hard to
improve and it is evident!

Demonstrates punctuality in attendance. Meets Meets

Question Comments Question Comments

(Midpoint): (Final):

Demonstrates dependability in all assigned Meets – Student is efficient in
tasks and projects. work ups and in projects. She
was asked to prepare a handout
for providers and completed a
Question Comments Question Comments thorough and attractive
(Midpoint): (Final): document in very little time!
Meets – Student prepared her
rough draft of her patient case
in advance for feedback, was
always prepared for topic
discussions and patient
presentations.

The student is professional and ethical in Meets Meets

attitude and behavior.

Question Comments Question Comments

(Midpoint): (Final):

The student accepts constructive criticism and
appropriately modifies behavior.
Question Comments Question Comments
(Midpoint): (Final):
Meets – Student consistently
asks for feedback and is eager
to put it into practice.
Meets – Student received some
crucial feedback at about the 2-
week mark and she took it upon
herself to implement that
feedback, which resulted in a
noticeable difference in her
patient work
ups/recommendations!

Open Ended Feedback

Please enter comments as appropriate. MIDPOINT FINAL
Please list specific strengths of the student Student’s willingness to learn, Student’s willingness to learn
noted during this rotation. openness to new opportunities, and grow remain her greatest
and efficiency are her biggest strength. She receives feedback
strengths. She is also a direct well and acts on that feedback.
Question Comments and effective communicator. She continues to be efficient
Question Comments
(Final): *Comment and a clear communicator.
(Midpoint):
Required

Please list specific areas needing improvement Student can (and we will) Student has developed a solid
which future preceptors should focus on during continue working on going to foundation of guideline-
subsequent rotations. the guidelines and primary directed therapy and can

Question Comments
Question Comments
(Final): *Comment
(Midpoint):
Required
literature rather than tertiary
resources. She can also work on
opening up conversation in
patient encounters by asking
broader questions and creating
a warm environment.
continue to strengthen this. She
can continue to work on
encouraging discussion in
patient interactions and on
presenting confidently.

What specific activities would you suggest for Leading patient appointments, Continue to lead patient
this student during future rotations which would drug information questions (if interactions or counsel patients
complement his or her experience(s) to date? they arise), presenting a on medications/devices. Present
treatment plan to the patient. the final treatment plan to the
patient. Continue to evaluate
Question Comments primary literature (especially as
Question Comments
(Final): *Comment it is published) for applicability
(Midpoint):
Required
to practice.

Section Weight: 0%

MIDPOINT Status
MIDPOINT Status: Student should receive a
ON TRACK grade if they are on track to
demonstrate proficiency and consistent
performance at or above expectations by the
end of their experience. Student should receive
a NOT ON TRACK grade if they are not on
track to demonstrate proficiency and consistent
performance at or above expectations by the
end of their experience, unethical (e.g.
consistent attendance/punctuality issues,
inappropriate language or communication). MIDPOINT FINAL
Based on the student's performance and the On Track! We appreciate PASS – We still appreciate
preceding criteria, recommend the student's Student’s attitude, efficiency, Student’s “can-do” attitude,
MIDPOINT rotation grade. and eagerness. It will be efficiency, and general
exciting to see her take helpfulness/willingness to help,
ownership of encounters and but we also appreciate her
Question Comments Question Comments continue to grow in the next 2 openness to feedback and work
(Midpoint): (Final): weeks. ethic! She’s been truly
enjoyable to have around the
FMC and in clinic!

Section Weight: 100%

Recommended FINAL Grade MIDPOINT FINAL

for Rotation
FINAL Grade: Student should receive a PASS
grade if they are proficient and consistently
perform at or above expectations. The student
displays attributes that are consistent with
readiness to enter general practice. Student
should receive a NO PASS grade if they
perform below expectations consistently,
require significant improvement, and/or does
not display attributes consistent with readiness
to enter general practice. Please note areas in
need of improvement in Comment Box.
AUTOMATIC NO PASS:

 Breaches patient confidentiality or

knowingly violates policies of the site
 Does not meet requirements and
expectations outlined by the preceptor
 Displays skills, abilities, and/or
knowledge deficiencies that are a
concern for patient care
 Professional behavior is inappropriate
and/or unethical (e.g. consistent
attendance/punctuality issues,
inappropriate language or
communication)

Based on the student's performance and the PASS PASS

preceding criteria, recommend the student's
FINAL rotation grade.

Question Comments Question Comments

(Midpoint): (Final):

Additional Monitoring by OEE Recommended

If the student has received one or more “below expectations/inconsistently/never” or "Fail", please check which, if
any, of the following the Office of Experiential Education should monitor for the student.

Final
Midpoint


Professionalism
Professionalism


Time Management
Time Management


Communication
Communication



Referral to OEE for Performance Improvement Plan

If the student has received one or more “below expectations/inconsistently/never” or "Fail", please check which, if
any, of the following improvement plans should be developed for the student.

Final
Midpoint
  

Time Management Skills Time Management Skills

 

Organizational Skills Organizational Skills

 

Communication Communication

 

Drug Information Skills Drug Information Skills

 

Therapeutics Drug Knowledge Therapeutics Drug Knowledge

 

Therapeutic Knowledge Deficits

For students who received a no pass recommendation due to therapeutic knowledge deficits, please list the specific
therapeutic topics for review prior to restarting patient care experiences.

Comments (Midpoint): Comments (Final):