School of Biomedical Sciences
FORM
E
Bachelor of Pharmacy
Subje
Subject
PHM490
Campus
Wagga Wagga
Assessment of Current Competencies and Supervisor’s Evaluation
Student’s name:
Student No:
Site name:
This form, to be completed by the student’s placement supervisor, is meant to provide constructive feedback to the student and
Charles Sturt University about the student’s relative strengths and weaknesses as demonstrated during the placement.
The supervisor should evaluate the student as objectively as possible by indicating in the relevant column that best describes the
student’s performance. If the quality in question is irrelevant to the work the student has been performing, please indicate as Not
Applicable
GENERAL
Preparedness
Attitude
Promptness and dependability
Appropriate appearance
Observance of rules, policies and procedures
Relations to others
Ability to learn
Skills and accuracy in work
Initiative
Student is self-directed in undertaking tasks
Student is cooperative and non-judgmental
Student is an active learner
Student’ ability to take on and follow through with
responsibilities
Willingness to solve problems
Ability to solve problems
Student demonstrates accountability
Responsiveness to criticism
Communication skills - oral
Student behaves in an ethical manner
1
Excellent
2
Very Good
3
Good
4
Unsatisfactory
5
Not Applicable
DISPENSING MEDICINES
1
Excellent
2
Very Good
3
Good
4
Unsatisfactory
5
Not Applicable
1
Excellent
2
Very Good
3
Good
4
Unsatisfactory
5
Not Applicable
Student is able to assess a prescription to ensure it is
valid
Student has a systematic approach to checking and
minimizing errors
Student is able to process the prescription using the
dispensing computing system
Student is able to use ancillary labels and advisory
statements
Student can describe and/or demonstrate
administration technique for commonly used
medicines, including inhalers, eye ointments and eye,
ear and nose drops
MEDICATION MANAGEMENT
Student’s ability in history taking and information
gathering by obtaining:

Information on the nature of the condition
of symptoms of clinical concern
 Medication history and current medication
treatment from the patient and patient
records
 A comprehensive education and lifestyle
history
 Essential health and medication related
information
Student assesses the presenting symptoms or
conditions utilising appropriate drug information
resources
Student identifies issues relevant and important to
the medication review
Student understands the education review case
and makes appropriate recommendations for a
range of drug, disease state, social and lifestyle
issues.
Student demonstrates good overall therapeutic
knowledge
Student’s ability in the following appropriate
counseling skills:
 Student is an active listener
 Student is able to tailor the
medication/disease related information to
the level of the patient (uses minimal
medical jargon)
 Student uses effective writing skills
Student is empathetic i.e. demonstrates
appreciation of others’ position, and consideration
towards others, identifies with others perspectives
Did you encounter any problems as supervisor? If yes, please comment.
What are the student’s outstanding STRENGTHS?
In what areas does the student need IMPROVEMENT?
What suggestions do you have to improve the pharmacy student Workplace Learning Program?
Supervisor’s signature OR type in name if
submitting form electronically
Please tick if this evaluation can be viewed by the student:
Please return your completed form by
SUBMIT
Or e-mail to: [email protected]