(To Be Completed By Peer-Evaluator)
Name of Student being evaluated:______________________________________________
Name of Evaluator:______________________________________________
At a minimum, did the student cover each of the following points during counseling?
|1. Introduced self and verified correct patient ||Y ||N ||Somewhat |
|2. Brand and generic name ||Y ||N ||Somewhat |
|3. Indication ||Y ||N ||Somewhat |
|4. Directions for taking ||Y ||N ||Somewhat |
|5. Common AND serious side effects ||Y ||N ||Somewhat |
Assessment of student performance:
|6. Did student communicate all necessary information? (special instructions or precautions) ||Y ||N ||Somewhat |
|7. Did the student maintain good eye contact? ||Y ||N ||Somewhat |
|8. Did the counseling flow smoothly and end well? ||Y ||N ||Somewhat |
|9. Did the patient receive the message communicated? ||Y ||N ||Somewhat |
Observations from group members
Did the student handle the situation appropriately? Explain specifically what was done well.
How could the student have handled the situation differently? Explain what could have been done to improve the counseling, the situation, or the outcome.