Summary: UCSD Skaggs School of Pharmacy and Pharmaceutical Sciences
Student Pharmacist Professionalism Evaluation Form
Preclinical Years (Years 1 through 3)
Student Name ____________________________________________ Course ____________________________________
Faculty Member __________________________________________ Quarter/Year _______________________________
Faculty Signature _________________________________________ Date Discussed with Student___________________
The above mentioned student has not demonstrated the personal and professional behaviors necessary for meeting the
standards of professionalism in pharmacy and requires education and/or assistance with the following (circle):
Unmet Professional Responsibility
a) Needs continual reminders about fulfilling academic responsibilities.
b) Cannot be relied upon to complete required tasks.
c) Misrepresents or falsifies actions and/or information.
d) Other (describe): _______________________________________________________________________________
Lack of Effort toward Self-improvement and Adaptability
a) Is resistant or defensive in accepting criticism.
b) Remains unaware of own inadequacies.
c) Resists considering or making changes in behavior.
d) Does not accept responsibility for errors or failures.
e) Is not respectful of colleagues and/or patients.
f) Is overly critical/verbally abusive during times of stress.