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Student Name:

Evaluator:

Criteria

Excellent

Meets Expectations

Needs Development

Unacceptable

Score

Student introduces self during communication with family member

(2 Points)

Student introduces self (name AND title, eg, Stephanie a pharmacy student) at the beginning of conversation

(1 Point)

Student introduces self (only name *OR* title, not both) at some point in conversation

----------------

n/a

(0 Points)

Student does NOT introduce self during conversation

 

Use of open-ended questions

(2 Points)

Student uses open-ended questions when appropriate to obtain medication history (at least 2 open-ended questions during conversation)

(1 Point)

Student uses at least 1 open-ended question to obtain medication history

----------------

n/a

(0 Points)

Student uses NO open-ended questions to obtain medication history

 

Obtaining medication history: herbal/OTC/vitamins/supplements

(1.5 Points)

Student asks specifically about herbal and/or OTC and/or vitamin and/or supplement patient use

----------------

n/a

----------------

n/a

(0 Points)

Student does NOT ask specifically about herbal or OTC or vitamin or supplement patient use

 

Obtaining medication history:

Specific for listed PMH / possibly untreated conditions

(eg, I see Mr. Smith has diabetes, what medication(s) does he take for that? eg, What does Mr. Smith use for cholesterol? Simvastatin? Atorvastatin?)

(1.5 Points)

Student asks specifically about treatment or medication for past medical history and/or disease state that has no treatment listed in chart

----------------

n/a

----------------

n/a

(0 Points)

Student does NOT ask specifically about treatment or medication for past medical history or disease state that has no treatment listed in chart

 

*Rubric was created by and used with permission from Kacie Monson, PharmD, BCPS.

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