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Quick Assignment Index

Student Performance Evaluation by Clinical Instructor (50%)

Explanation: Although frequent feedback will be provided to students by clinical instructors, student performance in this course will be formally evaluated at the midpoint and at the end of the clerkship.

Expectations: The clinical instructor with use the Midpoint evaluation to provide formative feedback on student performance at the 3-week point in the course. The Final evaluation will factor into the student’s course grade.

Evaluation: The clinical instructor will use the online SPE form to evaluate the student. The score will be entered in the Grading Record. Grades will not be reported to the Registrar’s Office until the evaluations are complete. See the Student Performance Evaluation in the General Manual for more information.

Patient Counseling (5%)

Explanation: Students are expected to demonstrate that they can perform patient consultations at a professionally acceptable level. These consultations will be performed under the direct observation of the clinical instructor.

Expectations: While each student should be observed closely and provided frequent feedback regarding patient consultation, some formal evaluation of counseling skills is required. Students will complete two Patient Counseling Evaluation Forms and upload them to the 743 course dropbox by 11:59pm of the last day of the block.

Evaluation: The clinical instructor should formally evaluate the student’s patient counseling skill on two separate occasions utilizing the Patient Counseling Evaluation Form. The first evaluation should take place during the first week of APPE rotation to provide a baseline evaluation and the opportunity for further skill development. The second evaluation should be completed during the 5th or 6th week to provide the student with summative feedback. The clinical instructor will enter the scores on the online grading record.

Herbal and Complementary Counseling (5%)

Explanation: Per ACPE, students will recommend prescription/nonprescription medications, dietary supplements, diet, nutrition, traditional non-drug therapies, and complementary and alternative therapies.

Definitions:

  1. Traditional medicine
    Traditional medicine is the sum total of the knowledge, skills, and practices based on the theories, beliefs, and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness.
  2. Complementary/alternative medicine (CAM)
    The terms “complementary medicine” or “alternative medicine” are used inter-changeably with traditional medicine in some countries. They refer to a broad set of health care practices that are not part of that country’s own tradition and are not integrated into the dominant health care system.
    *Complementary generally refers to using a non-mainstream approach together with conventional medicine.
    *Alternative refers to using a non-mainstream approach in place of conventional medicine.
  3. Herbal medicines
    Herbal medicines include herbs, herbal materials, herbal preparations and finished herbal products that contain as active ingredients parts of plants, or other plant materials, or combinations.
  4. Dietary supplements* are defined by DSHEA as
    • a vitamin or mineral,
    • an herb or other phytochemical,
    • an amino acid,
    • a dietary substance to supplement the diet by increasing the total dietary intake (for example,enzymes or tissues from organs or glands), or
    • a concentrate, metabolite, constituent, or extract of any of the foregoing
  5. Nutraceuticals*
    Nutraceuticals are dietary supplements that contain a concentrated form of a presumed bioactive substance originally derived from a food, but now present in a nonfood matrix, and used to enhance health in dosages exceeding those obtainable from normal foods.

* American Association of Clinical Endocrinologists Medical Guidelines for the Clinical Use of Dietary Supplements and Nutraceuticals. Endocrine Practice. 2003; 9(5):417-

See the 728-743 Resources page for additional resources.

Expectations: Students will counsel patients on at least three different herbal products and three different complementary products from the list of products on the Sample Log Form supervised by their clinical instructor. Students will track complementary and herbals consults provided by listing them in a HIPAA compliant log form. (See Sample Log Form.) Students will upload the log form on the course web page.

Evaluation: The clinical instructor will evaluate student herbal and complementary consults using the following evaluation score:

0 (NO)
Not done or Unacceptable		 1 (Inconsistent)
Some deficiencies with information provided.		 2 (YES)
Acceptable. Sufficient information provided

OTC Review (10%)

Explanation: Students will gain knowledge in OTC products at the site.

Expectations: Students will review six chapters of the latest edition of the Handbook of Nonprescription Drugs (or other comparable nonprescription drug handbook). Students will review one chapter each week of the APPE rotation. Students will complete the following when reviewing each chapter:

  1. Read the chapter by Tuesday of the assigned week.
  2. Review products in the assigned chapter that are available in the pharmacy – go to the OTC aisles to see the actual products.
  3. Review with the clinical instructor the following questions:
    • What are common ingredients / trade names for products in the assigned chapter?
    • What are the contraindications for products in the assigned chapter?
    • What are key counseling points for products in the assigned chapter?
    • What are key side effects for products in the assigned chapter?
    • When should a patient be referred to a health care provider versus being treated with products in the assigned chapter?
SuggestedChapterTopic
One5Headache
Two11/12Disorders Related to Cold and Allergy / Cough
Three13Heartburn and Dyspepsia
Four15Constipation
Five23Essential and Conditionally Essential Nutrients
Six41Minor Burns, Sunburn, and Wounds

Evaluation: The student and clinical instructor will review the questions listed above. The clinical instructor will discuss the questions and provide verbal feedback to the student. The clinical instructor will evaluate the student on the OTC activity using the evaluation following scale:

0 (NO)
Not done or Unacceptable		 1 (Inconsistent)
Some deficiencies with information provided.		 2 (YES)
Acceptable. Sufficient information provided

Medication Therapy Management (10%)

Explanation: Per APhA – Medication therapy management, also referred to as MTM, is a term used to describe a broad range of health care services provided by pharmacists, the medication experts on the health care team. As defined in a consensus definition adopted by the pharmacy profession in 2004, medication therapy management is a service or group of services that optimize therapeutic outcomes for individual patients. Medication therapy management services include medication therapy reviews, pharmacotherapy consults, anticoagulation management, immunizations, health and wellness programs and many other clinical services. Pharmacists provide medication therapy management to help patients get the best benefits from their medications by actively managing drug therapy and by identifying, preventing and resolving medication-related problems.

Expectations: Students will complete medication therapy management services (MTM) during the Community Pharmacy Clerkship. This activity will provide student pharmacists experience with intervention-based services and notifying health care providers with clinical recommendations.

During the required 743 APPE rotation, students will complete a minimum of thirty intervention-based services. The goal of this intervention-based service is to assist patients in improving their medication therapy. Students, with the help of the clinical instructor, should identify patients who would benefit from intervention-based services. Students will document the services using the usual platform at the practice site.

Students will upload their MTM training certificate / documentation on the 743-course web page.

OPTIONAL: During the required 743 APPE rotation, students MAY complete Comprehensive Medication Review and Assessment (CMR/A) services. The goal of CMR/As is for students to review subjective and objective data, identify, and resolve drug therapy problems. See the drug therapy work sheet posted on the course web page for examples of drug therapy problems. Students will bill for the CMR/As per the usual process at the practice site. If a site does not bill for CMR/A services, the student is not expected to submit billing for MTM services, however, the student is expected to complete at least one billing form. Students will document the CMR/As using the usual platform at the practice site.

CMR/As will consist of the following steps:

  1. Medication Therapy Review – the student will collect patient-specific information, assess medication therapies for drug therapy problems, develop a prioritized list of drug therapy problems and create a plan to resolve drug therapy problems.
  2. Personal Medication List – the student will create a comprehensive list of the patient’s medications including prescription, nonprescription, herbal, and supplements and provide it to the patient.
  3. Medication Action Plan – the student will create a medication action plan for the patient listing actions for the patients to use in tracking progress for self-management.
  4. Interventions and/or referral – as needed, the student will recommend interventions or referrals to other providers to optimize drug therapy.
  5. Documentation and Follow Up – MTM service is documented utilizing the usual process at the pharmacy practice site. A follow up visit is scheduled based on the needs of the patient.

    Sites use a variety of programs and platforms to support MTM documentation and billing. Platforms may be specific to the site or commercial products. An example of a commercial product typically used for eligible Medicare Part D members includes OutcomesMTM®. Another MTM program is the Wisconsin Pharmacy Quality Collaborative (WPQC) for eligible Wisconsin ForwardHealth (Medicaid) members. WPQC services may also be completed by participating in United Way of Dane County Medication Review events. Interested students should contact WSPS to participate in United Way of Dane County Medication Review events.

    Students should inquire about which MTM platform is used at the site and complete the MTM platform training by the end of week one. Students will upload the training certificate or submit a paragraph describing the completed training if a certificate is not provided. All students are encouraged to become WPQC certified regardless of the platform used at the site. Of note, there is no cost for WPQC certification for students.

Please note for students at 743 sites participating in the WPQC program:
If you are at a 743 site participating in the Wisconsin Pharmacy Quality Collaborative (WPQC), you are required to complete the WPQC training and upload the training certificate on the 743-course web page.

Please note for students at 743 sites NOT participating in the WPQC Program:
If you are at a 743 site that is not participating in the WPQC program, you are required to complete the site MTM training and upload the training certificate on the 743-course web page. In place of billing for the actual service, you will instead complete one billing form using the Information to Collect when Submitting WI Forward Health MTM Claims using the guidelines outlined in the WI ForwardHealth Provider Handbook. The billing form may be found on the course web page under MTM.

See the 728-743 Resources page for sample MTM platforms and WPQC Program Information.

Evaluation: The clinical instructor will enter the number of MTM interventions completed on the online grading record. The clinical instructor will also enter evaluation on the Student Performance Evaluation under Domain 2 – Essentials for Practice assessing MTM skills.

Immunization Activity

Explanation: Students in 728-743 will perform immunization activities as available at the site and according to Wisconsin state laws. Students may immunize as long as they have completed an immunization certification and the site has met all the requirements to immunize. UW students are covered by the State of Wisconsin to immunize during APPE rotations.

In addition, students will also participate in important public health immunization activities by participating in patient history and screening, patient counseling, documentation, administrative measures, and public education. Please see the article posted on the course webpage for guidance, “ASHP Guidelines on the Pharmacist’s Role in Immunization”.

Finally, students will review and discuss the influenza vaccine information sheets (VIS and VAERS), and immunization emergency protocol with the clinical instructor.

Expectations: Students should provide at least 30 immunizations if possible.

Students will review and discuss the influenza vaccine information sheets (VIS and VAERS) with the clinical instructor. See 728-743 Resources page for links to the required forms. Students will also review the site’s protocol on immunizations and emergency procedures. Students will review the protocol for any updates and provide a written summary to the clinical instructor. Sample protocols will be posted on the 743-course web page.

Students will upload their immunization certificate from their immunization training course as well as a written summary and updates of the site’s immunization protocol on the 743-course web page.

Evaluation: The clinical instructor will evaluate the student on the Immunization activity using the evaluation following scale:

0 (NO)
Not done or Unacceptable		 1 (Inconsistent)
Some deficiencies with information provided.		 2 (YES)
Acceptable. Sufficient information provided

Purchasing Activity

Explanation: Each student is required to participate in a purchasing activity during the community APPE.

Expectations: Purchasing Activity Options:

  • The student participates in a CII order, completing the manual or electronic 222 form and adjusting inventory and confirming receipt of drugs.
  • The student participates in fitting and ordering a DME item (e.g. compression stockings) for a patient.
  • The student reviews nightly prescription orders, ensuring that what is needed for the next day is on that order and then directs the technician to enter the order into the system.

Evaluation: The clinical instructor will evaluate the student on the Purchasing activity using the evaluation following scale:

0 (NO)
Not done or Unacceptable		 1 (Inconsistent)
Some deficiencies with information provided.		 2 (YES)
Acceptable. Sufficient information provided

Star Rating Activity

Explanation: Students will review the Star Rating material provided on the course web page.

Expectations: Students will answer the following questions and discuss their answers with the clinical instructor.

  1. Why did CMS create Star Ratings?
  2. What are the current Star Ratings for Medicare D Plans?
  3. Which ratings are influenced by pharmacies?
  4. How do plans evaluate pharmacies against the Star Ratings?
  5. What are the ratings for your current pharmacy site?
  6. Are there ratings that could be improved? What suggestions do you have for improvement?

Evaluation: The clinical instructor will evaluate the student on the Star Rating activity using the evaluation following scale:

0 (NO)
Not done or Unacceptable		 1 (Inconsistent)
Some deficiencies with information provided.		 2 (YES)
Acceptable. Sufficient information provided

Medicare B and D Coverage Activity

Explanation: Students will review the links to Medicare provided on the course web page.

Expectations: Students will answer the following questions and discuss their answers with the clinical instructor.

  1. What does Medicare Part A cover?
  2. What does Medicare Part B cover?
  3. What does Medicare Part D cover?
  4. Describe each of the following for a Part D plan – premium, deductible, copayment, and coinsurance.
  5. What is the coverage gap (ie $ starting and $ ending amounts) for the current year? What cost items count towards the coverage gap? What cost items do not count towards the coverage gap?
  6. Please note: pharmacists may not recommend a specific Medicare Part D plan to patients. For this activity students will look under Medicare.gov plan finder and identify the lowest estimated cost Medicare Part D plan for a patient living in your zip code who is over 65 with Medicare only on the following medications:
    • Aspirin 81 mg daily
    • Carvedilol 6.25 mg twice daily
    • Erlotinib 25 mg daily
    • Famotidine 40 mg daily
    • Finasteride 5 mg daily
    • Gemfibrozil 600 mg twice daily
    • Levothyroxine 100 mcg daily
    • Pravastatin 20 mg daily
    • Tamsulosin 0.4 mg daily

Evaluation: The clinical instructor will evaluate the student on the Medicare B and D activity using the evaluation following scale:

0 (NO)
Not done or Unacceptable		 1 (Inconsistent)
Some deficiencies with information provided.		 2 (YES)
Acceptable. Sufficient information provided

Insurance Activity

Explanation: Students will follow the process for a denied prescription claim (eg: refill too soon, prior authorization rejected) and assist pharmacy personnel in resolving the prescription claim.

Expectations: Answer the following questions and discuss with pharmacy personnel:

  1. What insurance information is needed from the patient?
  2. What is a BIN number? What is the function of this number?
  3. Why did the prescription get rejected?
  4. What steps were taken to resolve the rejected prescription?
  5. How long did the process take to complete?

Evaluation: The clinical instructor will evaluate the student on the Insurance activity using the evaluation following scale:

0 (NO)
Not done or Unacceptable		 1 (Inconsistent)
Some deficiencies with information provided.		 2 (YES)
Acceptable. Sufficient information provided

PEB Pharmacy Self-Inspection

Explanation: Each student is required to complete the State of Wisconsin Pharmacy Self-Inspection report as a part of the Community APPE.

Expectations: This assignment must be completed prior to the last day of the assigned APPE block.

** Pharmacy self-inspection forms are available at the Department Safety and Professional Services Web-site.

Students will NOT submit to the School the Pharmacy Self-Inspection form at the end of the rotation for grading purposes.

Evaluation: The clinical instructor will evaluate the student on the PEB Pharmacy Self-Inspection using the evaluation following scale:

0 (NO)
Not done or Unacceptable		 1 (Inconsistent)
Some deficiencies with information provided.		 2 (YES)
Acceptable. Sufficient information provided

ISMP Survey

Explanation: Each student is required to complete the Institute of Safe Medicine Practices (ISMP) survey as a part of the Community APPE.

Expectations: Complete questions #1-18 found on pages 9-10 of the ISMP Manual also posted on the course web page under ISMP Survey. Students will review and assess the questions using a letter grade described on the document of A, B, C, D, or E. (Please note: E is highest score and A is lowest score). If the assessment is an A, B, or a C, students will review the process relating to the question and write a written recommendation for improvement and discuss with your pharmacist.

Students will NOT submit to the School the Pharmacy the ISMP Survey form at the end of the rotation for grading purposes.

Evaluation: The clinical instructor will evaluate the student on the ISMP Survey using the evaluation following scale:

0 (NO)
Not done or Unacceptable		 1 (Inconsistent)
Some deficiencies with information provided.		 2 (YES)
Acceptable. Sufficient information provided

Prescription Dispensing Skill Affidavit

Explanation: Students are required to have the clinical instructor sign the Prescription Dispensing Skill Affidavit during the 728-743 APPE.

Expectations: The clinical instructor should periodically review and discuss the steps necessary to verify the accuracy of a dispensed prescription. Once the clinical instructor is confident in the students’ ability to verify the accuracy of dispensed prescriptions he or she may sign and date the Prescription Dispensing Skill Affidavit. Failure to meet this requirement will result in subsequent remedial APPE placement for the student until this professional competency is met.

The clinical instructor will sign the Prescription Dispensing Skill Affidavit on the student’s successful completion of the activity. Students will upload on the 743-course web page the completed form by 11:59pm of the last day of the block.

Evaluation: The clinical instructor will evaluate the student on the Prescription Dispensing Skill using the evaluation following scale:

0 (NO)
Not done or Unacceptable		 1 (Inconsistent)
Some deficiencies with information provided.		 2 (YES)
Acceptable. Sufficient information provided

Student Rotation Self-Evaluation (Required)

Explanation: See the Student Rotation Self-Evaluation Process for details.

Expectations: The following is an overview of the process:

  • A BASELINE self-evaluation is done ONCE prior to the start of the first APPE rotation of the year. The baseline self-evaluation must be reviewed with the site clinical instructor during the first week.
  • SMART Goals must be entered by the end of week 2.
  • A post-rotation self-evaluation must be completed at the end of each rotation. It must be reviewed by the student and site clinical instructor during the last week of each block.
  • In subsequent blocks, the post-rotation self-evaluation from the previous block must be reviewed with the site clinical instructor during the first week.
  • Failure to complete the self-evaluation will result in an “incomplete” for the block.

Reflection Document (required)

Expectations: Students will write a paragraph reflecting on a learning opportunity or memorable professional development event that occurred during the rotation. Students will upload on the 743-course web page a copy of the reflection by 11:59pm of the last day of the block.

iTOFT (Optional)

Explanation: See the APPE Evaluations in the General Manual for a full description of the tool.

Expectations: Instructors will verify when the iTOFT evaluation is completed. The iTOFT evaluation is accessible from the grading record.

Evaluation: When an instructor chooses to complete the iTOFT, the evaluation score is not factored into the final course grade.

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