Core Advanced Pharmacist e-portfolio

Clinical evaluation exercise (mini-CEX) example


Evaluates a global clinical encounter with a patient assessing the synthesis of skills essential for clinical care such as history taking, communication, examination and clinical reasoning.

Examples of when it can be used

  • Provision of care to a patient in clinic with highly complex problems requiring clinical judgement is required e.g. multimorbidity, complex polypharmacy
  • Diagnosis and management of an acute or chronic condition requiring advanced clinical assessment and clinical reasoning e.g. a chest infection, side effect from chemotherapy


  • Provide feedback on what the pharmacist did well and areas for development.
  • The overall rating should reflect the expected level of an advanced pharmacist as defined in the curriculum.
  • ‘Not applicable’ means that the pharmacist did not cover the identified area as it was not within the context of the procedure or case.
  • ‘Below expected level of performance’ means that either the pharmacist did not cover the identified area to a competent level or it was not demonstrated at all, and should.



Title *

Poly-pharmacy review with elderly diabetic patient

Date of assessment *



Collaborator Details

Collaborator name *


Collaborator email

Only required for sending ticketed invitations

[email protected]

Collaborator position *

Consultant Pharmacist

Collaborator profession *


Collaborator declaration *

I can confirm I have read the RPS collaborator guidance and have the appropriate experience to complete this assessment. I confirm I have completed the assessment objectively and independently.



Details of Case

Summary of case*


I recently reviewed an elderly diabetic patient in clinic. During the review I had a local consultant pharmacist sit in with me and observe.

The patient was a 75yr old man, who had type-2 diabetes, chronic kidney disease 3 (eGFR 52ml/min), hypertension, coronary heart disease and heart failure (severe LVSD).

He was on glicalzide, metformin, sacubitril/valsartan, bisoprolol, eplerenone, furosemide, aspirin, atorvastatin, and paracetamol.

His HbA1C was still poorly controlled (85mmol/mol), despite excellent adherence. He complained of some fatigue, and some osmotic symptoms.

On history taking. He had NYHA 2 heart failure symptoms. He reported no paroxysmal nocturnal dyspnoea or orthopnoea. He reported no chest pain. He reported slight postural dizziness, which affected him 4/10. He reported no palpitations.

My examination confirmed BP 140/90mmHg sitting and 128/85mmHg standing. His pulse was 62bpm and regular. His chest was clear on auscultation. He displayed no peripheral oedema, and the skin on his legs was notably dry.

He was judged to be slightly hypovolaemic, as he displayed some clinical signs of dizziness and dehydration, and also had a moderately elevated urea (14.5mmol/l).

The patient had a few competing risks including dehydration, heart failure, CKD and diabetes. Finding a balance between these was difficult.

After discussing things with the patient, and explaining the pros and cons, we jointly decided to temporarily stop his furosemide (previously 40mg daily). I educated the patient on symptom monitoring and daily weighs. We put in place a safety net, asking him to call us should he start to become oedematous, or if his weight started to climb. We also discussed returning to using furosemide for a short 3-day course when required (e.g. if his symptoms return over a weekend).

To manage his diabetes (fatigue and osmotic symptoms) we also started him on dapagliflozin. This medication also had the potential to help his shortness of breath relating to heart failure. Its diuretic effect may also account for the stopping of his furosemide. I counselled the patient on hypoglycaemia, diabetic ketoacidosis, and genitourinal infection risk. We also explained some sick day guidance.

We arranged a follow-up review for symptomatic status, general observations and bloods in 2 weeks.

The exact extent to which his fluid balance would be affected by these two changes was, at best, uncertain. However, we provided a clear safety net and the plan was developed jointly with the patient.

Clinical setting*

General Practice clinic

Focus of clinical encounter *

History  Diagnosis  Management  Information provision

Level of complexity*

Low      Medium      High


Collaborator Assessment


Is respectful, courteous, and professional in their approach to patients and others. Is accountable and responsible for own decisions. Works within ethical guidelines and legal frameworks. Actively practices honesty and integrity. Works safely within own level of competence, knows when to escalate or refer *




Not applicable

Comments: strengths and/or areas for development *

Respectful and professional throughout.

Communication and consultation skills

Communicates using clear patient friendly language, establishes rapport. Explores patient’s understanding of their clinical condition and beliefs including identifying and addressing patients’ ideas, concerns and expectations. The patient is appropriately involved throughout the consultation. *




Not applicable

Comments: strengths and/or areas for development *

Really took the time to listen to the patient and find out what was important for them. Also, expertly managed to convey complex information and evidence to the patient, when attempting to help the patient make an informed decision.

Clinical reasoning

Takes a logical, appropriately thorough and focused history. Performs an appropriate physical and/or mental state examination, selecting and interpreting appropriate investigations. Makes an appropriate working diagnosis or decision.  *




Not applicable

Comments: strengths and/or areas for development *

First rate clinical reasoning. Logical and appropriate.

Clinical management

Applies clinical knowledge and skills to manage options and medicines appropriately and safely. Assesses and critically evaluates appropriate information to make evidence-based decisions. Makes appropriate use of referrals and prioritises care appropriately. *




Not applicable

Comments: strengths and/or areas for development *

There are potentially different ways in which the case could have been managed, but I agree entirely with the path chosen. We discussed what factors would have changed the management plan, and I found that the pharmacist was able to clearly explain scenarios when they may have chosen a different plan.

Organisation & efficiency

Effectively, efficiently and safely manages multiple priorities. Manages own time and workload calmly. Organises and delegates tasks appropriately to optimise effectiveness within the pharmacy and wider team, to enhance patient care. *




Not applicable

Comments: strengths and/or areas for development *



Summary of Assessment

Overall rating *

Based on your observation of this clinical episode, rate the overall level at which the pharmacist has shown that they are performing


Below the level expected of an advanced pharmacist

Working towards the level expected of an advanced pharmacist

Meets the level expected of an advanced pharmacist

Other relevant comments or feedback


Agreed action(s)


Learner's reflection

Describe what you have learned. How will it change your practice in the future?

To get feedback like this from a local well respected consultant pharmacist is really confidence building – I am really chuffed!



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Consider what learning outcome(s) this record provides evidence for and map to all that apply

  • 1.3 Always keeps the person at the centre of their approach to care when managing challenging situations; empowers individuals and, where necessary, appropriately advocates for those who are unable to effectively advocate for themselves
  • 2.2 Undertakes a holistic clinical review of individuals with complex needs, using a range of assessment methods, appropriately adapting assessments and communication style based on the individual.
  • 2.3 Demonstrates effective clinical reasoning skills, making autonomous, evidence informed, person-centred decisions about treatment for individuals or groups with complex clinical needs, managing risk in the presence of significant uncertainty

Linked Evidence

Consider if this records links to any other pieces of evidence within your portfolio.