Surgery Logbook 2013

LOGBOOK
Medical Student
Clerkship Program

Name : __________________________________________________

Main Preceptor : _________________________________________________

Date : _____________________ to _______________________

DEPARTMENT OF SURGERY
FACULTY OF MEDICINE
UNIVERSITAS PADJADJARAN
2013

STUDENTS IDENTITY

Name
Batch number
Place / Birthdate
Phone number
:
:
:
:

/

Photo 4x6

Using this Logbook

1. The use of this logbook is a mandatory during clerkship
rotation in Department of Surgery, as well as during
rotation in sattelite hospital.
2. The purpose of this logbook is for students appraisal and
evaluation during all activities in department of surgery.
The logbook should be signed by the preceptor each time
the teaching activities had been conducted.
3. Every skills activities should be written down according to
designated page. For example, if you join a major surgery,
write it down on the operating room pages.
4. Logbook must be handed to department of surgery on the
last day of rotation

PRECEPTORSHIPS NOTE
Division
Date
Preceptor
:
:
:
Digestive Surgery

Activities Cases Signature
BST

CRS

CSS

Mini CEx

Division
Date
Preceptor
:
:
:
Plastic Surgery

BST

CRS

CSS

Mini CEx

PRECEPTORSHIPS NOTE
Division
Date
Preceptor
:
:
:
Cardiothoracic Surgery

BST

CRS

CSS

Mini CEx

Division
Date
Preceptor
:
:
:
Urology Surgery

BST

CRS

CSS

Mini CEx

PRECEPTORSHIPS NOTE
Division
Date
Preceptor
:
:
:
Pediatric Surgery

BST

CRS

CSS

Mini CEx

Division
Date
Preceptor
:
:
:
Vascular Surgery

BST

CRS

CSS

Mini CEx

PRECEPTORSHIPS NOTE
Division
Date
Preceptor
:
:
:
Oncology Surgery

BST

CRS

CSS

Mini CEx

Division
Date
Preceptor
:
:
:
Orthopaedic Surgery

BST

CRS

CSS

Mini CEx

PRECEPTORSHIPS NOTE
Division
Date
Preceptor
:
:
:
Neurosurgery

BST

CRS

CSS

Mini CEx

Division
Date
Preceptor
:
:
:
Surgery .

BST

CRS

CSS

Mini CEx

Clinical Skills and Activities
(in accordance with Indonesian Standard of Medical Competencies or
Standar Kompetensi Dokter Indonesia / SKDI 2012)

Expected level of clinical skills competencies (SKDI)
Based on SKDI, clinical skills competencies are divided to 4 levels,
based on the Millers pyramid (knows, knows how, shows, does);

Level of competencies 1: Knows and able to explain
Graduated student must have theoretical knowledges of a medical
skill, and able to explain the procedural skills to friend, colleague,
patient, or client about the concept, theory, principles, and
indication, as well as how to do it, the possible complications, etc.

Level of competencies 2: Knows how; had seen or demonstrated
skill (including concept, theory, principle, indication, how to do it,
complications, etc.). Graduated student had seen the medical skill or
had others demostrated the medical skill directly applied to patient.

Level of competencies 3: Shows; had performed or applied the
skillunder supervision
skill (including concept, theory, principle, indication, how to do it,
complications, etc.) as well as mastering the bioethical background
and psychosocial impact. Graduated student had seen,
demonstrated, and performed or applied the medical skill to real
patient under supervision, and practice the medical skill to a model
or standardized patient.

Level of competencies 4: Does; perform the skill independently
Graduated student can demonstrate his/her ability to perform a
medical skill by mastering the whole theories, principles,
indications, procedural steps, complications and how to deal the
complications. Had performed the medical skill under supervision.

4A: Achieved the medical skill after graduation
4B: Achieved the medical skill after internship or obtain the skill by
post graduate course.

Clinical skills competencies Level
Note: yellow color indicate as possible as national OSCE case
Vascular surgery:
List of Clinical Skills:
Carotid artery palpation 4A
Palpation of peripheral arterial pulses 4A
Capillary refill time 4A
Detection of bruit 4A
Brodie Trendelenburg test 4A
Perthes test 3
Homans test 3
Ankle-brachial index 3
Doppler ultrasound 2
Venous puncture 4A
Arterial puncture 3
Finger prick 4A
Venous cutdown 3
Pediatric venous cutdown 3

Cardiothoracic surgery:
Respiratory inspection 4A
Chest inspection 4A
Chest auscultation 4A
Chest percussion 4A
Chest palpation 4A
Pleural tap 3
Superficial FNAB 2
Trans thoracal needle aspiration 2
Needle decompression 4A
Chest tube insertion 3
Water Sealed Drainage (WSD) care 4A
Pleural puncture 3
Oxygen therapy 4A

Digestive surgery:
Abdominal inspection and palpation 4A
Groin inspection and palpation 4A
Hernia palpation 4A
Psoas sign and obturators sign 4A
Digital rectal examination 4A
Nasogastric tube insertion 4A
Endoscopy 2
Nasogastric tube suction 4A
Colostomy bag replacement 4A
Enema 4A
Anal swab 4A
Gastroscopy 2
Proctoscopy 2
Ascites sampling 3
Abdominal ultrasound 2

Pediatric surgery
History taking from third party, or older children,
or anxious parents
4A
General pediatric physical examination 4A
Congenital malformation observation 4A
Pediatric peripheral IV cannulation 4A
Pediatric intubation 3
Oropharynx tube insertion 2
Intraosseus cannulation 2
Circumcision 4A
Airway, breathing management 3
Emergency rehidration 4A

Plastic surgery
Infiltration anesthesia
4A
Local nerve block
4A
Topical anesthesia
4A
Wound suturing
4A
Suture removal
4A
Analgesic administration
4A
Incision and drainage of abscee
4A
Excision of benign skin tumor
4A
Wound care
4A
Rozerplasy
4A
Bandaging
4A

Urology
Bimanual kidney examination
4A
Costovertebral angle tenderness examination
4A
Bladder palpation
4A
Prostate palpation
4A
Bulbocavernous reflex
3
Uroflowmetry
1
Plain abdomen and IVP x-ray interpretation
3
Urethral catheterization
4A
Clean intermitten catheterization
3
Suprapubic puncture
3
Circumcision
4A
Penis, scrotum inspection and palpation
4A
Scrotum transilumination test
4A

Surgical Oncology
Self-Breast examination education
4A
Lymph node examination
4A
Breast examination
Not listed in SKD
Thyroid examination
Not listed in SKD
Skin cancer examination
Not listed in SKD

*not listed in SKDI but considered important

Orthopaedic surgery
Inspection and palpation of gait, extremities,
vertebral, scapulae, pevic, neck
4A
Range of Motion examination
4A
Shoulder girdle test
4A
Join function test
4A
Leg discrapency examination
4A
Close fracture reposition
3
Fracture stabilisation
4A
Reduction of dislocation
3
Application of Dressing
4A
Join aspiration
2
Splinter removal
3

Neurosurgery
Glasgow Coma Scale examination
4A
Vertebral inspection, percussion, and palpation
4A
Skull x-ray interpretation
4A
Vertebral x-ray interpretation
4A
Head CT-Scan and interpretation
2

List of general Clinical Skills:
Skin test
4A
Blood test examination
4A
Plain x-ray interpretation
4A
Contrast x-ray interpretation
3
Minor surgery prep: a and antiseptic, local
anesthesia
4A
Observer or assistant in major surgery:
Scrubbing, Gowning, Gloving
4A
Patient transport
4A
Basic life support
4A
Mask ventilation
4A
Intubation
3
Fluid resuscitation
4A

Clinical Skills in Surgery Clinic
Nu. Patients name Age Sex

Diagnosis
Treatment plan
Skills
Operator/assistant
Date Sign


Diagnosis
Treatment plan
Skills
Operator/assistant
Date Sign


Diagnosis
Treatment plan
Skills
Operator/assistant
Date Sign


Diagnosis
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Skills
Operator/assistant
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Diagnosis
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Operator/assistant
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Diagnosis
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Skills
Operator/assistant
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Diagnosis
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Skills
Operator/assistant
Date Sign


Diagnosis
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Skills
Operator/assistant
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Diagnosis
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Operator/assistant
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Diagnosis
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Operator/assistant
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Diagnosis
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Skills
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Diagnosis
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Diagnosis
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Skills
Operator/assistant
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Diagnosis
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Skills
Operator/assistant
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Diagnosis
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Skills
Operator/assistant
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Diagnosis
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Skills
Operator/assistant
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Diagnosis
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Skills
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Diagnosis
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Skills
Operator/assistant
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Diagnosis
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Skills
Operator/assistant
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Diagnosis
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Skills
Operator/assistant
Date Sign


Diagnosis
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Skills
Operator/assistant
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Diagnosis
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Skills
Operator/assistant
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Diagnosis
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Skills
Operator/assistant
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Diagnosis
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Skills
Operator/assistant
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Diagnosis
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Skills
Operator/assistant
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Diagnosis
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Skills
Operator/assistant
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Diagnosis
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Skills
Operator/assistant
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Diagnosis
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Skills
Operator/assistant
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Diagnosis
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Skills
Operator/assistant
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Diagnosis
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Skills
Operator/assistant
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Diagnosis
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Skills
Operator/assistant
Date Sign


Diagnosis
Treatment plan
Skills
Operator/assistant
Date Sign

Activities in Ward

Diagnosis
Treatment plan
Skills
Operator/assistant
Date Sign


Diagnosis
Treatment plan
Skills
Operator/assistant
Date Sign


Diagnosis
Treatment plan
Skills
Operator/assistant
Date Sign


Diagnosis
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Skills
Operator/assistant
Date Sign


Diagnosis
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Skills
Operator/assistant
Date Sign


Diagnosis
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Skills
Operator/assistant
Date Sign


Diagnosis
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Skills
Operator/assistant
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Diagnosis
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Skills
Operator/assistant
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Diagnosis
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Skills
Operator/assistant
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Diagnosis
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Skills
Operator/assistant
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Diagnosis
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Skills
Operator/assistant
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Diagnosis
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Skills
Operator/assistant
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Diagnosis
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Skills
Operator/assistant
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Diagnosis
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Operator/assistant
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Diagnosis
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Skills
Operator/assistant
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Diagnosis
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Operator/assistant
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Diagnosis
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Diagnosis
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Operator/assistant
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Diagnosis
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Skills
Operator/assistant
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Diagnosis
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Skills
Operator/assistant
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Diagnosis
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Skills
Operator/assistant
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Diagnosis
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Skills
Operator/assistant
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Diagnosis
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Skills
Operator/assistant
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Diagnosis
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Operator/assistant
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Diagnosis
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Diagnosis
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Operator/assistant
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Diagnosis
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Operator/assistant
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Diagnosis
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Diagnosis
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Operator/assistant
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Diagnosis
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Skills
Operator/assistant
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Diagnosis
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Skills
Operator/assistant
Date Sign

Activities in Emergency Room

Diagnosis
Treatment plan
Skills
Operator/assistant
Date Sign


Diagnosis
Treatment plan
Skills
Operator/assistant
Date Sign


Diagnosis
Treatment plan
Skills
Operator/assistant
Date Sign


Diagnosis
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Skills
Operator/assistant
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Diagnosis
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Operator/assistant
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Diagnosis
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Operator/assistant
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Diagnosis
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Operator/assistant
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Diagnosis
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Skills
Operator/assistant
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Diagnosis
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Operator/assistant
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Diagnosis
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Skills
Operator/assistant
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Diagnosis
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Skills
Operator/assistant
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Diagnosis
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Skills
Operator/assistant
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Diagnosis
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Skills
Operator/assistant
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Diagnosis
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Skills
Operator/assistant
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Diagnosis
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Skills
Operator/assistant
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Diagnosis
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Skills
Operator/assistant
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Diagnosis
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Operator/assistant
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Diagnosis
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Operator/assistant
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Diagnosis
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Operator/assistant
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Diagnosis
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Operator/assistant
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Diagnosis
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Operator/assistant
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Diagnosis
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Operator/assistant
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Diagnosis
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Operator/assistant
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Diagnosis
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Operator/assistant
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Diagnosis
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Operator/assistant
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Diagnosis
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Operator/assistant
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Diagnosis
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Operator/assistant
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Diagnosis
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Operator/assistant
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Diagnosis
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Diagnosis
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Skills
Operator/assistant
Date Sign

Activities in Operating Room

Explanation:
Op/A/Ob : Operator / Assistant / Observer Anesthesia : local/general etc
OR Activities : Preparing surgery, scrubbing, etc El / EMG : Elective / Emergency
Surgery : appendectomy, herniorrhaphy, etc

Nu. Patients name
Age
M/F
Anestesi

Diagnosis
El / EMG
Surgery Sign
OR activities
Date Op/A/Ob

Nu. Patients name
Age
M/F
Anestesi

Diagnosis
El / EMG
Surgery Sign
OR activities
Date Op/A/Ob

Nu. Patients name
Age
M/F
Anestesi

Diagnosis
El / EMG
Surgery Sign
OR activities
Date Op/A/Ob

Nu. Patients name
Age
M/F
Anestesi

Diagnosis
El / EMG
Surgery Sign
OR activities
Date Op/A/Ob

Nu. Patients name
Age
M/F
Anestesi

Diagnosis
El / EMG
Surgery Sign
OR activities
Date Op/A/Ob

Nu. Patients name
Age
M/F
Anestesi

Diagnosis
El / EMG
Surgery Sign
OR activities
Date Op/A/Ob

Nu. Patients name
Age
M/F
Anestesi

Diagnosis
El / EMG
Surgery Sign
OR activities
Date Op/A/Ob

Nu. Patients name
Age
M/F
Anestesi

Diagnosis
El / EMG
Surgery Sign
OR activities
Date Op/A/Ob

Nu. Patients name
Age
M/F
Anestesi

Diagnosis
El / EMG
Surgery Sign
OR activities
Date Op/A/Ob

Nu. Patients name
Age
M/F
Anestesi

Diagnosis
El / EMG
Surgery Sign
OR activities
Date Op/A/Ob

Nu. Patients name
Age
M/F
Anestesi

Diagnosis
El / EMG
Surgery Sign
OR activities
Date Op/A/Ob

Nu. Patients name
Age
M/F
Anestesi

Diagnosis
El / EMG
Surgery Sign
OR activities
Date Op/A/Ob

Nu. Patients name
Age
M/F
Anestesi

Diagnosis
El / EMG
Surgery Sign
OR activities
Date Op/A/Ob

Nu. Patients name
Age
M/F
Anestesi

Diagnosis
El / EMG
Surgery Sign
OR activities
Date Op/A/Ob

Nu. Patients name
Age
M/F
Anestesi

Diagnosis
El / EMG
Surgery Sign
OR activities
Date Op/A/Ob

WEEKLY MEETING
WITH SUPERVISOR RESIDENT

Supervisor Resident:
.

Nu. Date Residents signature
1.
2.
3.
4.
5.
6.
7.
8.
9.

Tutor activities with resident

Date Topic
Signature and
residents name

Night Shift Activities

Shift Date Chief Residents name Signature
1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

17.

18.

19.

20.

21.

22.

Final Evaluation

Examiner

Cases

Date

Signature

Assignments

Order by Assignment topic

Reason for
assignment

Order by Assignment topic

Reason for
assignment

Pemberi tugas Assignment topic

Reason for
assignment

Sattelite Hospital
Attendance
Week / Date
. to.
Sattelite hospital
(name)
Supervisor
Signature

Surgery Logbook 2013

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