The E*Value form for collecting co-curriculum and interprofessional experiences and reflections will ask for the following information. It is slightly different from the list posted on the web page – please use this current version.

  1. Event date: Add using this format: MM/DD/YYYY ______

(Events between May 15, 2017 and May 14, 2018 are eligible for reporting this year)

  1. Type of Event: (check one of three options available – choice depends on which criteria event meets)

____Co-curricular: Not tied to any course; no credit received for doing it; organized by school or community group

____Interprofessional: students or practitioners from one or more other healthcare disciplines are also participating; these activities may be for credit or they may co-curricular.

____Both(co-curricular and interprofessional):

  1. Professions Present:Check all that apply. (If you check more than one option other than pharmacy, be sure you indicated the event is interprofessional or both in question 2)

Select / Options / Select / More Options
Physician / Student Physician
Physician Assistant / Student Physician Assistant
Nurse / Student Nurse
Nurse Practitioner / Student Nurse Practitioner
Physical / Occupational Therapist / Student Physical/Occupational Therapy
Social Worker / Student Social Worker
Psychiatrist / Psychologist / Student Psychiatrist / Psychologist
Dentist / Student Dentist
Dietitician / Student Dietician
Pharmacist / UM Pharmacy Student P1 P2 P3 P4
Pharmacy Resident (PGY1) / Student Pharmacist from other school
  1. Activity

This list is really long! I suggest starting by determining which general type of activity you are describing since activities are arranged in that order.

General types of activities are:

  • School Service (e.g., committees, helping students or faculty)
  • Professional (e.g., organized through an association or meeting)
  • Community Event (e.g., organized by community group but students can join event)
  • Student organized (e.g., student association events – KE,KPsi,ASP, RhoChi, ACCP)
  • Interprofessional (required = in a class; optional=outside of class)

select
School Service – Participating in a Committee (Admissions, Assessment, Curriculum, other)
School Service - Student Advocacy & Representation (Dean’s Student Leadership Group, ACPE Self Study)
School Service – Participating on a student panel (Board of Visitors, ACPE site visit)
School Service – Faculty Hiring & Evaluation Process (Search Committee, SEC, FEC)
School Service – Pharmacy student admissions process (recruitment, interviews, application reviews)
School Service – Tutoring or mentoring
School Service – Assisting with program or event (white coat ceremony, graduation ceremony, picnic)
Activity List continued…….
School Service – Fundraising events for the School
School Service – Other (specify in the event description)
Professional – Student Member of Montana Pharmacy Association (MPA)
Professional – Present at or assist with a professional meeting (e.g., ASHPMidyear, NW Regional, MPA)
Professional – Legislative Day Participant (in Helena)
Professional – Other (specify in event description)
Community Event – Health Screening Events (IPHARM)
Community Event – Health Fairs (MIUHC, UM Student Health Fair, Southgate Mall event)
Community Event - Vaccination events
Community Event – Other (specify in event description)
Student organized – Professional presentations (Clinical practitioner round table, Breast Cancer brunch)
Student organized – Fundraising for student organization
Student organized – Educational sessions for general public (Generation Rx, Poison Prevention, Operation immunization, diabetes, heart and self-care)
Student organized – Research support (Juvenile Diabetes Research Foundation, Relay-for Life)
Student organized – Public health & Wellness(Red Cross Blood Drive, Medicare enrollment assistance, clothing & toiletry drive, sandwich preparation, food donations, highway cleanup)
Student organized – Patient and family support (Ronald McDonald House dinners, Make-a-Wish
Student organized – Healthy families (Boys & Girls Club events, Adopt-a-Family, fun run, Senior Center bingo)
Student organized – Pharmacy meetings (MRM planning or hosting)
Student organized – Awards and Appreciations (faculty breakfast, teacher of the month/year, initiation dinners)
Student organized – Pharmacy student enrichment (game night, social events)
Student organized – Other (describe in the event description)
Interprofessional, required – Introductory IPE lecture (PHAR 300, Fall P1)
Interprofessional, required – Health Professions guest speakers (PHAR 310, Spring P1)
Interprofessional, required – Introductory Pharmacy Practice Experience (PHAR 480 or 481, P1 or P2 year)
Interprofessional, required – Assistive Devices lab with Physical Therapy (PHAR 463, Spring P2)
Interprofessional, required – Physical Assessment (PHAR 560, Fall P3)
Interprofessional, required – SimMan STEMI lab (PHAR 563, Spring P3)
Interprofessional, required – Patient care teams (during APPEs, all year P4)
Interprofessional, optional – AHHS 491 (Interprofessional Education elective)
Interprofessional, optional – Service Learning projects that include other providers (PHAR 391/591)
Interprofessional, optional – Simulations (invitations from other programs)
Interprofessional, optional – Screening clinics with Physical Therapy (in the Skaggs lobby)
Interprofessional, optional – Other event (describe in the event description)
  1. Sponsoring Organization (select all that apply to the activity)

APhA-ASP
Kappa Epsilon
Kappa Psi
Rho Chi
AACP
Other pharmacy student organization
Pharmacy School faculty
Campus group
Community group
MPA (Montana Pharmacy Association)
Other Professional Pharmacy Organization
Other (Specify in narrative)
  1. Activity Description (Include name of event, target population/disease, and your role (i.e., what you did for the event).

Add 1-2 paragraph description here.

  1. Time Involved (round to closest number of hours) ______
  1. ACPE Standards (Areas where the activity helped you develop professional skills) Select all that apply. See separate table at end of this documentthat shows examples of types of activities that most likely provide opportunities for working on these various skills areas but answer based on your actual experience.

STANDARD
1.1Foundational Knowledge application
2.1 Patient-Centered Care
2.2 Medication Use
2.3 Health and Wellness
2.4 Population-based Care
3.1 Problem Solving
3.2 Education for patients or general public
3.3 Patient Advocacy
3.4 Interprofessional Collaboration
3.X Effective Teamwork
3.5 Cultural Sensitivity
3.6 Communication with patients or general public
4.1 Self-Awareness of knowledge and/or skill levels
4.2 Leadership
4.3 Innovation, Creative Thinking, or Entrepreneurship
4.4 Professionalism
  1. Reflection (Describe how your participation in the activity helped you work towards the professional skills selected in question 8)

Format recommendation – list each item selected in question 8 on a separate line then add 1-2 sentences after each one describing how the activity contributed to your growth in that area.

Examples:

Leadership: I was in charge of a group of 4 students who prepared materials for the event. I gained experience in getting a group to complete a project task.

Innovation/creative thinking: I was asked to find a new way to get the general public to attend the health fair. I used social media instead of radio PSAs and it seemed to work.

End of Questions for E*Value Form.

There are more ideas about standards and skills on next page if needed.

Reference Table for Possible Activities that Promote Development of Professional Skills by Standard

(Use information when answering questions 8 & 9; these are only suggestions – other activities may apply or touch on other skills)

Std / Title / What it means for a pharmacy student: / Co-curricular / Inter-professional
1.1 / Foundational Knowledge Application / Apply classroom knowledge to a real patient case or real-life project / Health Fairs
Screening events
Immunization
Education event / Health Fairs
Screening events
2.1 / Patient-Centered Care / Provide care to patients that considers their needs and abilities / Health Clinics
2.2 / Medication Use / Review prescriptions to ensure appropriate
Advise patients on proper use
Review entire medication therapy to ensure best combination / Brown Bag
2.3 / Health and Wellness / Promote behaviors and knowledge that reduce the risk of illness or injury and increase physical and mental well-being / Fun Run
Poison Prevention
2.4 / Population-based Care / Develop or apply guidelines for specific populations of patients that can be used in decision-making / Health Clinics
3.1 / Problem-solving / Take steps to fix or solve an issue related to an event or activity / All events / All events
3.2 / Education for patients or general public / Prepare and provide written or verbal materials that are appropriate for the audience / Health Fairs
School events
3.3 / Patient advocacy / Intervene or represent the interests of a patient in a healthcare setting / n/a / Care team
3.4 / Interprofessional collaboration / Work or learn with individuals from one or more other disciplines / Wellness Clinics
Screening events / Wellness Clinics
Screening events
3.X / Effective teamwork / Work well with others to plan, perform, and review activities or prepare materials / Student-run events / Care teams
3.5 / Cultural Sensitivity / Interact with all patients and other providers in an appropriate manner that demonstrate awareness of cultural influences. Be respectful and responsive. / Health Fairs
Wellness Clinics
Screening events
Education events / Patient care
Health Fairs
Wellness Clinics
Screening events
3.6 / Communication with patients or general public / Effectively give and receive information from a variety of individuals or groups / Health Fairs
Wellness Clinics
Screening events
Education events / Patient care
Health Fairs
Wellness Clinics
Screening events
4.1 / Self-awareness of knowledge and/or skill levels / Identify skills or knowledge needed to successfully complete a task or increase level of independence in performing patient care / All events / All events
4.2 / Leadership / Take responsibility for a group or a task to ensure the group functions effectively or the task is successfully completed / Student-run events
Tasks for events
Represent students
Take responsibility for others
4.3 / Innovation, Creative Thinking, or Entrepreneurship / Given a task or project, provide ideas and thoughtful input to assist with planning, preparation or performance / All events / All events
4.4 / Professionalism / Behave in a manner that is respectful, thoughtful, and facilitates appropriate patient care processes / All events / All events