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Direct Patient Care Rotations

Goals, Objectives and Evaluation Tools and Resources


1. Direct Patient Care Rotation Goals and Objectives [click to view as a PDF]

The following goals and objectives pertain to all direct patient care rotations and can be found in the rotation summary for each direct patient care rotation.  Rotation-specific goals and objectives outlined in the rotation summaries are considered in addition to the overall direct patient care rotation goals and objectives.  The resident will be evaluated on his/her ability to meet these goals and objectives during each direct patient care rotation and throughout the residency year.  Given the specialized nature of the clinical orientation rotation and the precepting skills rotation, these rotations have their own goals and objectives which can be found in their respective rotation summaries. 

Goal 1: Develop and integrate the knowledge required to provide direct patient care as a member of the interprofessional team.

Objectives:
The resident will be able to:

  1. Relate knowledge of the pathophysiology, risk factors, etiology and clinical presentation of medical conditions, including symptoms, physical assessment data, relevant diagnostics, and laboratory findings to patient-specific clinical findings to make appropriate, patient-specific drug therapy recommendations. (CPRB 3.1.4.e)
  2. Relate knowledge of pharmacology, pharmacokinetics, pharmaceutics, and evidence-based therapeutics pertaining to medication therapy to patient-specific clinical findings to make appropriate, patient-specific drug therapy recommendations. (CPRB 3.1.4.e)
  3. Acquire and utilize knowledge of safe medication practices to manage and improve medication use for patients. (CPRB 3.2.5)

Goal 2: Demonstrate the necessary pharmaceutical care skills to provide direct patient care as a member of the interprofessional team.

Objectives:
The resident will be able to:

  1. Place a high priority on, and be accountable for, selecting and providing care to patients who are most likely to experience drug therapy problems. (CPRB 3.1.3)
  2. Establish a respectful, professional and ethical relationship with the patient and their caregivers. (CPRB 3.1.4.a)
  3. Gather relevant patient information by conducting a patient interview and from all other appropriate sources. (CPRB 3.1.4.c.d)
  4. Develop a prioritized medical problem list and describe the current active issues that are responsible for the patient’s hospitalization or clinic visit. (CPRB 3.1.4.e)
  5. Identify, prioritize and justify patient-specific drug therapy problems. (CPRB 3.1.4.b)
  6. Identify goals of therapy and advocate for the patient in meeting their health-related needs and their desired goals of therapy. (CPRB 3.1.2)
  7. Identify, prioritize, assess and justify all reasonable therapeutic alternatives and discuss the advantages and disadvantages of each alternative, considering efficacy, safety, patient factors, administration issues and cost. (CPRB 3.1.4.e)
  8. Develop, justify and communicate patient-specific recommendations for all identified drug therapy problems. (CPRB 3.1.4.e.f)
  9. Design and implement monitoring plans and plans for continuity of care that accommodate new or changing information and provide patient education and continuity of care. (CPRB 3.1.4.g.h)
  10. Proactively communicate healthcare issues, recommendations and care plans verbally to the appropriate team members and the patient. (CPRB 3.1.4.f.i, 3.2.4.c)
  11. Proactively document healthcare issues, recommendations and care plans, as appropriate in the health care record. (CPRB 3.1.4.e.f.i, 3.2.4.b.c)
  12. Effectively respond to medication- and practice-related questions and educate others in a timely manner, utilizing a systematic literature search and critical appraisal skills and appropriate means of communication (verbal or written, as appropriate). (CPRB 3.5.1.a.b.c.d.e)

Goal 3: Demonstrate the attitudes and behaviours that are hallmarks of a practice leader and mature professional.

Objectives:
The resident will be able to:

  1. Demonstrate responsibility for his or her own learning, through the refinement and advancement of critical thinking, scientific reasoning, problem-solving, decision-making, time management, communication, self-directed learning, teamwork and interprofessional skills. (CPRB 3.4.1)
  2. Demonstrate commitment to the profession, collaboration and cooperation with other healthcare workers, and an understanding of the role of the pharmacist in the interprofessional team in the improvement of medication use for patients. (CPRB 3.1.1, 3.2.2, 3.3.3)

 

Preceptor Orientation to New Direct Patient Care Rotation ITER [Click to view Presentation Handout]

 

2. Direct Patient Care Rotation ITER (In-Training Evaluation of Resident) [Click to view Form]

During and at the end of the each direct patient care rotation (DPC), the resident will be evaluated on his or her abilities in three core domains:

  • Knowledge
  • Skills (Provision of Pharmaceutical Care)
  • Attitudes and Behaviours (Professional Characteristics) 

These domains and their evaluation criteria reflect the knowledge, skills, attitudes and behaviours required of residents to successfully complete the residency program and are hallmarks of professional clinical pharmacists.  Each of these domains and their evaluation criteria are linked to a Canadian Pharmacy Residency Board (CPRB) competency and associated requirement, which residents are expected to achieve by the end of the residency year. 

Direct Patient Care ITER Performance Rubrics

Below are the performance rubrics used in the DPC ITER.  These rubrics outline the levels of performance to which the resident will be evaluated in the knowledge and skills domains.  These rubrics can be used by both the resident and preceptor to understand the performance requirements for each level of performance in the DPC ITER.  They also allow for standardization of resident assessment across rotations and preceptors. 

Knowledge Rubric [Click to view as PDF]

The Knowledge Rubric is based on Blooms Taxonomy.  It outlines the levels of performance for each evaluation criterion in the knowledge domain to which the resident will be evaluated throughout the rotation.  There are four levels of performance.  These levels of performance reflect the stages of learning that an adult (i.e. resident) undertakes when acquiring, interpreting and relating new knowledge.  They are ordered from basic (Remembering) to complex (Analyzing) and reflect a cumulative hierarchy whereby the resident has to master the more basic level of performance before moving to the more complex level of performance.

 

Skills (Provision of Pharmaceutical Care) Rubric [Click to view as PDF]

The Skills Rubric is based on the Dreyfus Model of Skill Acquisition.  It outlines the levels of performance for each evaluation criterion in the skills domain to which the resident will be evaluated throughout the rotation.  There are four levels of performance.  These levels of performance reflect the stages of learning that an adult (i.e. resident) undertakes when learning a new skill.  They are ordered from basic (Novice) to sophisticated (Proficient) and reflect a cumulative hierarchy whereby the resident has to master the more basic level of performance before moving to the more sophisticated level of performance.

 

Level of Patient or Problem Complexity Frame of Reference

This means that for each direct patient care rotation, regardless specialty area of the rotation,  the resident is to be evaluated, using the DPC ITER, on their knowledge, skills, attitudes and behaviours in caring for moderately complex patients and solving moderately complex drug therapy problems.  Each performance level outlined in the Knowledge Rubric and Skills Rubric pertains to the resident’s ability to care for moderately complex patients and solve moderately complex drug therapy problems.

Evaluating the Resident Using the DPC ITER

When evaluating the resident using the DPC ITER:

  1. Each evaluation criterion is associated with a description of the relevant components that pertain to that evaluation criterion.
  2. Below each level of performance there is an example description of a resident’s performance as it relates to the particular performance level.
  3. When evaluating the resident, the preceptor can use the example description and corresponding level of performance in the appropriate rubric to determine the resident’s level of performance at the mid-point and end of the rotation.  Note that these levels of performance represent a cumulative hierarchy.  This means, for example, that by evaluating the resident as “competent” for a specific evaluation criterion, the resident has already met the criteria for “novice” and “advanced beginner”.
  4. In the comment box below the evaluation criterion, the preceptor should provide evidence and feedback to support the attained performance level.
  5. At the end of the evaluation form, there is an opportunity to evaluate the resident on any rotation specific or resident personal rotation objectives that the preceptor or resident feels are not encompassed by the above evaluation criteria.

Resident Expected Level of Performance [Click to view as PDF]

The table below outlines the goal level of performance for the resident throughout the residency year, based on the number of direct patient care rotations that he or she has completed or is in the process of completing.   In some cases, residents should have achieved a particular level of performance by an early stage in the residency year, meaning that the remainder of the year is focused on refining and further developing the attained level of performance.

 

How is this Table Used?

This table is to be used by the resident and preceptor as a guide to understanding the expected level of resident performance at various stages of the residency year. 

  • Residents can use this to better understand their current level of performance as it relates to the time point during the residency year and their progress towards meeting the goal level of performance.  It can also help residents identify focus areas for improvement and further development.
  • Preceptors can use this to better understand the resident’s current level of performance as it relates to how the resident is expected to be performing at that stage in the residency year.  If a resident is not at the expected level of performance, then the preceptor can work with the resident to provide learning opportunities to further develop the required competency.
  • The Program Coordinator will refer to this table to assess the resident’s progress towards meeting the goal level of performance throughout the residency year.  When it is noted that the resident is not yet at the expected level of performance at a particular time point, the Program Coordinator will work with the resident and preceptor, as appropriate, to help the resident develop a learning plan to address the areas requiring further development and focus.            

 3. Clinical Orientation Rotation ITER [Click to view Form]

 This ITER will be used to evaluate the resident at the end of the Clinical Orientation Rotation.  The evaluation criteria are taken directly from the clinical orientation rotation summary.

 4. Precepting Skills Rotation ITER [Click to view Form]

 This ITER will be used to evaluate the resident at the end of the Precepting Skills Rotation.  The evaluation  criteria are taken directly from the precepting skills rotation summary.

 

-Last updated June 7, 2018