Evaluation of Clinical Skills in Pharmaceutical Education: Past, Present and Future Michael S. Monaghan, Ross E. Vanderbush and Alan B. McKay College of Pharmacy, University of Arkansas for Medical Sciences, 4301 W. Markham, Slot 522, Little Rock AR 72205 The purpose of this paper was to review past and present methods employed for the evaluation of clinical skills demonstrated on clerkships. The ideal method would: (i) assess the knowledge base from all areas of clerkship activities, (ii) assess problem-solving skills, (iii) assess communication skills, (iv) serve as a diagnostic tool for identifying deficiencies, (v) be conducted in a clinical environment, and (vi) be objective. Historically, various methodologies were utilized and these are reviewed. Currently, the principal process used for evaluation includes rating scales. These are usually combined with written and/or verbal examina- tions, or simulated experiences for selected course objectives. Both in the past and now, a variety of evaluation methods have been used, but none thoroughly assess cognitive learning, mastery of essential practice skills, nor measure the ability to use patient data in realistic problem-solving. A potential future method which would meet these goals is discussed. INTRODUCTION Colleges of pharmacy are encouraged to implement curricu- lar changes based on the concept and philosophy of pharma- ceutical care(1,2). Pharmaceutical care involves the use of a treatment plan for the purpose of achieving patient-specific outcomes that will positively affect the quality of life(3). To effect pharmaceutical care, the pharmacist must obtain crucial patient-specific information, integrate this informa- tion with pre-existing pharmacotherapy knowledge, and reach a decision on the most appropriate course of action. The experiential component of a curriculum allows students to synthesize didactic information within the realm of phar- macy practice, providing the necessary preparation for the execution of pharmaceutical care. Because more emphasis is being placed on experiential programs, more emphasis must be placed on evaluation of student performance in practice settings. Appropriate evalu- ation of student performance demonstrates that necessary practice competencies are realized. It also serves as a con- tinuous quality control measure between clinical clerkships, ensuring that each site teaches necessary student skills for performance of practice competencies. An evaluation method which can achieve both goals must be an objective, standardized and consistent approach that is also valid and reliable(4). The prototype evaluation method would: 1. assess the student’s knowledge base in all areas of activi- ties experienced during the clerkship; 2. assess the student’s problem-solving skills under actual clinical conditions; 3. assess communication skills; 4. serve as a diagnostic tool for identifying both students’ and clerkship sites’ deficiencies; 5. be conducted in an actual clinical environment; and 6. be objective and minimize errors of assessor judgement(4). The American Council on Pharmaceutical Education (ACPE) further recognizes that clinical evaluation should measure cognitive learning, mastery of essential practice skills, and the ability to use data in realistic problem-solv- ing(5). Unfortunately, few existing methods provide this range of application. The purpose of this review was to examine evaluation methods of the past and present, as well as to propose a method for the future. PAST A thorough review of past methods employed in the evalu- ation of experiential education exists(6). This paper will review only those attempts to assess clinical skills. One of the first advanced efforts at evaluating clinical skills was published by Warner in 1970(7). This approach combined behavioral objectives, defined skills to be demonstrated, and utilized six instruments for evaluation. These instru- ments for evaluation were a test of applied drug knowledge, analysis of student written assignments, a log of student activity, direct observation, evaluation of services performed by students, and a questionnaire for self-evaluation com- pleted by clerkship students. The purpose of the project was more to develop a clinical clerkship than to evaluate clinical skills of students. However, the study showed that students exhibited significant gains in their ability to apply pharma- ceutical knowledge. Specific reliability and validity mea- surements were not performed. Elenbaas and Jacoby developed a behavioral rating scale for the evaluation of pharmacy residents in the clinical setting(8). Advantages of this behaviorally based evalua- tion over traditional, nonbehavioral methods included in- creased objectivity through the limiting of evaluator bias, 354 American Journal of Pharmaceutical Education Vol. 59, Winter 1995